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December 26, 2001

Cervical Cancer Screening in Developing Countries

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(24):3079-3081. doi:10.1001/jama.286.24.3075

To the Editor: Dr Goldie and colleagues1 suggested that, in resource-poor countries, direct visual inspection (DVI) of the cervix and testing for human papillomavirus (HPV) may be reasonable alternatives to Pap smears in screening for cervical cancer. We have several concerns about this conclusion. First, the cost of a Pap smear is of central importance to cost-effectiveness analyses of cervical screening. Because Pap screening is labor intensive, salaries are a central component of its costs. Because of differences in professional fees, a Pap smear costs $15 in the United States2 and less than $0.40 in developing countries such as Vietnam.3

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