COLPOSCOPY AS A PRIMARY SCREENING-TEST FOR CERVICAL-CANCER

Aim and background: To evaluate the cost effectiveness of screening by colposcopy compared to conventional cytology, Methods: A prospective study was performed in the Florence District screening center on 3,000 consecutive women, self referring, who were examined by cytology and colposcopy in a blind fashion. Further assessment was based on cytolog ic report or on colposcopy-directed punch biopsy, Actual costs of the whole screening process were known. The cost effectiveness of differen t possible simulated screening scenarios was then determined, Results: Overall, 18 high-grade lesions (CIN3 = 9, CIN2 = 9) were detected, Fo ur different screening scenarios were compared, namely a) cytology alo ne, b) cytology + repeat smear for ASCUS (atypical squamous cells of u ndeterminate significance) cases, c) colposcopy + cytology for cases o f condyloma at punch biopsy, and d) colposcopy alone. Although they ha d a higher cost er examined woman (a) 17.98, b) 19.40, c) = 23.86, d) = 22.10 US$), scenarios c) and d = 88.8%) had a higher relative sensit ivity (a = 44.4, b = 61.1, c = 100, d = 88.8%) and a lower cost per hi gh-grade lesion detected (a = 6,743, b = 5,291, c = 3,977, d = 4,144 U SS). Conclusions: Screening by colposcopy is a feasible procedure whic h is more sensitive and more cost effective than conventional cytologi c screening. At least in those settings where access to cytopathology may be difficult, screening by colposcopy should be considered as a po ssible alternative.