Decision analysis for best management of mildly dyskaryotic smear

Refining the Management of Low-Grade Cervical Abnormalities in the UK National Health Service and Defining the Potential for Human Papillomavirus Testing: A Commentary on Emerging Evidence

“…This led to the question of whether it is justified to continue to manage women differently based on their cervical cytologic results, or whether colposcopy facilities be increased to accept everyone with abnormal smear results. There has been controversy about the most effective and efficient management of the large numbers of women who have minor cytologic abnormalities, in most of whom cervical cancer will not develop [6][7][8][9][10][11][12][13] for some time. More recently, the discovery that certain HPV types are implicated in the cause of cervical cancer [20,21] has led to the suggestion that HPV testing could be a basis for selective referral of women for colposcopy [22] and introduced a new factor in the debate about the management of women with lowgrade abnormal smear results.…”

“…There are substantial cost implications for the women concerned, and for the NHS. For some time, there has been controversy about the most effective and efficient management of the large numbers of women who have minor cytologic abnormalities, in the vast majority of whom cervical cancer will never develop [6][7][8][9][10][11][12][13]. The main methods proposed are continuing cytologic surveillance or referral for immediate colposcopy, or perhaps in the future, a choice between cytologic surveillance and immediate colposcopy conditional on a positive human papillomavirus (HPV) test result.…”

Management of women with smears showing mild dyskaryosis

“…In view of this and the need to take additional smears the group believed that a policy of cytological surveillance was likely to be more expensive and less efficient. This hypothesis is also supported by Johnson and colleagues, who used decision analysis to compare the expected mortality and cost associated with immediate referral with those associated with cytological surveillance 6. The risk of ultimately developing invasive cancer was the same in both groups, but the cost was greater if a conservative policy (cytological surveillance) was adopted.…”

Management for Doctors: Decision analysis for medical managers

“…Business people often use it, 3 and much of the literature refers to their problems 4. An increasing amount of published data concerns health management problems such as neonatal intensive care of very low birthweight infants5 or colposcopy 6. The conclusions are often surprising.…”