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January 26, 1990

Cervical Cytology and Reimbursement Issues

JAMA. 1990;263(4):514-515. doi:10.1001/jama.1990.03440040053017

To the Editor.—  Dr Ohrt,1 editorializing on the Bethesda classification of cervical/vaginal cytology, writes as follows: "Using a conservative, established protocol for the first follow-up of a mildly abnormal Papanicolaou test result, we can estimate that the conservative physician's treatment of a low-grade squamous epithelial lesion will result in an added cost in the range of $50 to $70." He references this statement with a technical bulletin from the American College of Obstetrics and Gynecology. In review of this technical bulletin, there is no "treat and repeat approach" for mildly abnormal Papanicolaou smears. The bulletin, in fact, states that "although a repeat Pap smear may be of benefit in confirming the diagnosis of pre-invasive cervical neoplasia... [a] single negative report on a repeat smear does not eliminate the need for a thorough diagnostic evaluation."2Dr Ohrt also characterizes low-grade squamous intraepithelial lesions as "relatively innocuous." It is true