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Impact of the Bethesda System
1Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Cancer
|November 15, 1995
Summary
The Bethesda System improved Pap smear diagnosis quality but increased abnormal results, with an estimated $1 billion cost for additional evaluations. Its impact on cancer prevention remains uncertain.
Area of Science:
- Gynecology
- Cytopathology
- Public Health
Background:
- The Bethesda System standardizes cervical cytology classification.
- Its clinical utility and impact on management have been debated globally.
- This study evaluates its effect on cervical screening and patient management.
Purpose of the Study:
- To assess the impact of the Bethesda System on cervical cancer screening.
- To evaluate changes in diagnostic terminology and management decisions.
- To analyze the effect on abnormal Pap smear rates and subsequent healthcare costs.
Main Methods:
- A MedLine search was conducted for comparative statistical data.
- Evaluation focused on specimen adequacy, human papillomavirus (HPV) in squamous intraepithelial lesion (SIL) classification, and abnormal Pap smear rates.
- Diagnostic and treatment outcomes for atypical squamous cells of undetermined significance (ASCUS) and low-grade SIL were reviewed.
Main Results:
- By 1992, 85% of labs used Bethesda terminology.
- 5-13% of ASCUS smears and 18.6% of low-grade SIL diagnoses indicated high-grade cervical lesions.
- Abnormal Pap smear rates increased, leading to an estimated $1 billion in additional evaluation costs.
Conclusions:
- The Bethesda System enhanced Pap smear diagnostic quality in the US.
- An increase in abnormal Pap smear results is partly attributed to Bethesda terminology.
- The overall effect on cervical cancer prevention is currently unknown.
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