Cost-yield of Routine Papanicolaou Smear Screening in a Clinic for Sexually Transmitted Diseases

Because women who attend sexually transmitted diseases clinics have a greater risk of developing cervical cancer than do nonattenders, the authors assessed the cost-yield of routine Papanicolaou screening at the Denver metro Health Clinic. From February 1, 1981 to October 31, 1983, the authors offered Papanicolaou screening to women 25 years of age or older who would sign an agreement accepting responsibility for follow-up. To enhance the cost-yield of identifying a population of women at high risk for a seriously abnormal result who might not otherwise obtain screening, the authors excluded women under 25 years and women with recent smears or conditions complicating interpretation of the smear. Follow-up efforts included a sequence of mailed reminders, telephone calls, certified letters, and home visits. Of 697 initial smears, 40 (5. 7%) showed some evidence of atypia, and 12 (1. 7%) of these showed dysplasia. Colposcopic or surgical biopsy confirmed dysplasia in three, carcinoma in situ in two, and invasive cervical carcinoma in one. Only 53 patients (7. 6%) contacted the clinic for results, and the clinic was able to reach only 49 of 102 women with abnormal smears. The direct cost of the program was about 15, 000. Although the rate of dysplasia was relatively low, adequate follow-up proved to be the main barrier to maximizing the cost-yield of Papanicolaou smear-screening in the clinic. It may be necessary for each large sexually transmitted diseases clinic to perform a pilot study to determine whether or not the costs of performing routine Papanicolaou smears are justified by the yields.