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November 28, 1986

Papanicolaou Smear Testing in Elderly Women-Reply

JAMA. 1986;256(20):2819-2820. doi:10.1001/jama.1986.03380200057019

In Reply.—  Drs Kochersberger and Studenski raise important issues to be considered in designing strategies for screening and disease prevention in the elderly. We are completing a cost-effectiveness analysis of our cervical cancer screening program to address these questions. The analysis tests the effects of varying the uncertain parameters of the natural history of cervical cancer, Papanicolaou smear testing, and quality of life on the cost-effectiveness of the program.There is little information in the literature on cervical carcinoma that is specifically applicable to elderly women. Data do suggest that cervical cancer behaves in a more biologically aggressive manner in older women. The transition time between stages of cervical abnormalities has been observed to elapse four times more rapidly in elderly women compared with younger women.1 Epidemiologic observations consistent with rapid disease progression in the elderly yield estimates of between three to nine years for progression from normal cervical