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To the Editor.—
The article by Whitehead, Reyner, and Lindenbaum (226, 1421, 1973) implicating folate deficiency as a causative factor in epithelial cell abnormalities in the uterine cervix should not remain unchallenged. By the authors' own admission, their thesis is not supported by any other evidence of folate deficiency. The contention of this article is based primarily on a very modest clinical trial on eight patients whose abnormalities "improved" three weeks after initiation of folic acid therapy. The fate of the remaining 14 patients who should have served as controls is not given.Nothing is more fallacious in the follow-up of patients than the assessment of the status of cervix epithelium based on a single smear. A smear obtained three weeks after a preceding smear may show no abnormalities of note in the presence of a substantial lesion. The authors did not use colposcopy to ascertain the status of the
Koss LG. Megaloblastic Changes in Cervical Epithelium. JAMA. 1974;227(11):1262. doi:10.1001/jama.1974.03230240020014
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