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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: Dr Denny and colleagues¹ studied screen-and-treat approaches to cervical cancer screening in low-resource settings. We question whether these approaches should be characterized as safe, effective, or resource-appropriate in a real-world setting.

Supply, equipment, salary, space, and overhead costs for Papanicolaou tests in developing countries such as Vietnam total less than $0.50 per test.² Supply costs alone for the human papillomavirus (HPV) test total $20 to $30 per test²; when analyzed in developing-country laboratories there is difficulty with reproducibility and accuracy that is comparable to cytology.³

Denny et al used colposcopic biopsies to evaluate the possibility of invasive carcinoma among women in their study. However, in real-world settings screen-and-treat would require performing cryosurgery without biopsy on screen-positive women. Under a screen-and-treat approach, considerable proportions of women screened would be informed that they have a positive screening result for cervical cancer; cryosurgery may render it impossible to determine . . . [Full Text of this Article]

Eric J. Suba, MD
eric.suba@kp.org
Kaiser Permanente Medical Center
South San Francisco, Calif

Kim R. Geisinger, MD
Wake Forest University Baptist Medical Center
Winston-Salem, NC

Matthew A. Zarka, MD
Mayo Clinic
Scottsdale, Ariz

Stephen S. Raab, MD
University of Pittsburgh Medical Center
Pittsburgh, Pa

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