Innovations in Pap Screening for Cervical Neoplasia

The Papanicolaou (Pap) smear has been credited with reducing deaths from cervical cancer over recent decades. Retrospective studies have shown that 49% to 72% of patients with cervical cancer had not been screened or had been improperly screened, but 30% to 50% of women with cervical cancer had had a normal smear within the past 3-4 years. About 25% of the estimated 8000 false-negative Paps a year are potentially preventable by refinement of Pap readings and an additional 25% by improvement in the sampling technique/process. On the other hand, an equal number of cases of cancer will not be detected by the Pap smear. Two innovations have been introduced to improve Pap screening: speculoscopy and automated re-readings of negative Pap smears. Technical improvements in Pap smears, however, may result in only a limited improvement in mortality from cervical cancer. Improving patient compliance with screening, plus education to reduce behaviors that raise the risk of cancer, may have more of an impact on the mortality rate.