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Feasibility of Management of High-Grade Cervical Lesions in a Single Visit
A Randomized Controlled Trial
Wendy R. Brewster, MD, PhD;
F. Allan Hubbell, MD, MSPH;
Joan Largent, MPH, PhD;
Argyrios Ziogas, PhD;
Fritz Lin, MD;
Susan Howe, MPH;
Theodore G. Ganiats, MD;
Hoda Anton-Culver, PhD;
Alberto Manetta, MD
JAMA. 2005;294:2182-2187.
Context The incidence of cervical cancer is higher among low-income and minority women who have never undergone a conventional Papanicolaou test or who do not follow up after testing. Screening has been shown to reduce cervical cancer incidence rates.
Objectives To determine the feasibility and acceptability of immediately treating women with severely abnormal Papanicolaou test results by using a single-visit cervical cancer screening and treatment program and to compare treatment rates and 12-month follow-up rates with those of women who received usual care.
Design, Setting, and Participants Randomized controlled trial conducted among 3521 women aged 18 years or older recruited between January 1999 and April 2002 at US community health centers located in predominantly Latino underserved areas.
Interventions Women randomized to usual care (n = 1805) were discharged immediately after examination. Women randomized to the single-visit group (n = 1716) remained at the clinic until the results of their conventional Papanicolaou test were available. Large loop electrosurgical excision procedure was performed in single-visit patients with either a diagnosis of a high-grade squamous intraepithelial lesion (HGSIL)/atypical glandular cells of undetermined significance (AGUS) or suspicion of carcinoma. All other patients with abnormal Papanicolaou test results were referred to abnormal cytology clinics or elected to receive follow-up care outside the study’s medical system.
Main Outcome Measures Treatment rates for HGSIL/AGUS at 6 months, follow-up rates at 6 months for lower-grade lesions, and 1-year follow-up rates for all patients.
Results The rate of abnormal Papanicolaou test results was 4.1%. One percent of results showed high-grade lesions. In the single-visit group, the mean visit time was 2.8 hours and the mean time for delivery and processing of the Papanicolaou tests was 66 minutes. Six months after randomization, 14 (88%) of 16 single-visit and 10 (53%) of 19 usual care patients with HGSIL/AGUS had completed treatment. Fifty percent in the single-visit program and 53% of usual care with less abnormal Papanicolaou tests completed treatment within 6 months. Overall, 36% in each group presented for a follow-up Papanicolaou test 1 year later. Women in the single-visit group with high-grade lesions (10/16; 63%) were significantly more likely to attend follow-up for Papanicolaou tests 12 months later than women with similar lesions in the usual care group (4/19; 21%).
Conclusions For cervical cancer screening, the single-visit program was feasible and the degree of acceptability was high in this underserved population. Single visit programs provide an opportunity to increase the rate of immediate treatment and follow-up of women with severely abnormal Papanicolaou test results. This strategy did not improve follow-up rates for women with less-abnormal results.
Trial Registration http://ClinicalTrials.govIdentifier: NCT00237562
Author Affiliations: Departments of Medicine (Drs Brewster, Hubbell, Largent, Ziogas, Lin, Anton-Culver, and Manetta), Obstetrics and Gynecology (Drs Brewster and Manetta), and Pathology (Dr Lin), School of Medicine, University of California, Irvine; Project Concern International, San Diego, Calif (Ms Howe); and Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego (Dr Ganiats).
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