August 27, 1997

The Papanicolaou Test and Screening for Cervical Cancer-Reply

Author Affiliations

The Medical University of South Carolina Charleston

JAMA. 1997;278(8):634. doi:10.1001/jama.1997.03550080044030

The review of the literature by Drs Vasilev and Scott regarding the effectiveness of the Pap test is limited and misleading. Probably the most comprehensive, recent, governmentsponsored expert review on this question was performed by the Office of Technology Assessment and published in 1990.1 The review concluded "most sensitivity rates reported in the literature are between 56% and 95%"—far from the figure of 20% to 35% cited by Vasilev and Scott from a flawed meta-analysis.2 A subsequent letter to the editor in the American Journal of Epidemiology also pointed out how the study underestimated Pap test sensitivity.3 Even the authors of the meta-analysis concede "there is good evidence that Pap test screening is effective."2 Most studies suggest that approximately half of the false-negative results relate to inadequate sampling procedures,4 a limitation that can be considerably improved with use of modern endocervical brush devices, of a