Assessing secondary prevention methods for cervical cancer: costs and benefits in managed care

Secondary prevention of cervical cancer through regular screening has been very successful since its widespread adoption in the 1940s. The death rate for cervical cancer declined 74% between 1955 and 1992, presumably owing to the introduction of the Papanicolaou's cervical smear (Pap test) and greater use of organized screening. Until now, this is the closest we have come to scoring a win in the ongoing fight against cervical cancer. Although secondary measures for preventing cervical cancer remain a mainstay in managed care, screening methodologies and processes have several inherent weaknesses, largely because successful screening depends on patient cooperation and adherence. Screening rates have improved, but approximately 20% of the target population in commercial plans remains unscreened. Weaknesses related to the specificity and sensitivity of cervical screening methodologies compound the problem of preventing cervical cancer through screening. Secondary prevention methods constitute the greatest proportion of direct costs in cervical disease, by far. Should a patient receive an abnormal test result, costs accelerate significantly. Methods used to resolve test abnormalities, such as repeat screening, colposcopy/biopsy, and human papillomavirus deoxyribonucleic acid testing, add to the overall financial burden of secondary prevention in these cases.