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To the Editor: Mr Brown and Dr Garber¹ present an interesting model evaluating the cost-effectiveness of new methods for improving cervical cancer screening. Principles of public health practice suggest that the best screening programs are those involving relatively common conditions that can have a significant impact on quality of life and for which there are acceptable, available, and affordable tests and treatments.² New technologies claim to enhance the sensitivity of the Papanicolaou (Pap) test and increase the likelihood that a precancerous lesion will be detected in a single visit. This is particularly important in high-risk underserved areas where annual screening visits can be difficult to achieve.

The issue that must be addressed is the extent to which the increased sensitivity and subsequent improvements in detection, prevention, and quality of life are worth the marginal increase in costs. Unfortunately, the indicator of effectiveness in Brown and Garber's model, number of years . . . [Full Text of this Article]

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