"One of the concerns for adopting HPV-based screening is the lower CIN2+ specificity of HPV testing, compared with cytology, leading to higher screen positive rates and the resulting need for more colposcopies
Physicians and advanced-practice clinicians in this country who perform colposcopies
have been trained to do so, but they have never had minimum standards by which to model and assess their performance.
This is especially the case with the modified RCI and Swede Score, where the underestimated diagnoses were rather high, consistent with approximately 1/3 of HSIL underdiagnosed colposcopies
in other reports [27, 28].
TABLE 1 CIN 2 and 3 treatment options: An outcomes comparison COMPARISON ODDS RATIO OF TREATMENTS OUTCOME/MORBIDITY (95% CI) Laser ablation vs Laser ablation had more 7.45 (1.68-33) cryotherapy perioperative severe bleeding Laser ablation had higher 4.64 (2.98-7.27) rates of future adequate colposcopy Laser conization vs Laser conization had higher 2.73 (1.47-5.08) knife conization rates of future adequate colposcopy Laser conization had less 0.39 (0.25-0.61) cervical stenosis Laser conization vs Laser conization had more LEEP severe pain during procedure 5.36 (1.02-17.2) LEEP had fewer inadequate 0.27 (0.08-0.89) future colposcopies
Source: Martin-Hirsch et al, Cochrane Database Syst Rev 2000.
But they used the number of colposcopies
and the number of tests conducted as their proxy for harms, primarily because these were more easily measured.
Among the 30 women with abnormal colposcopies
there were 15 LSIL, 13 HSIL and 2 case suspicious of malignancy.
Similar trends were observed for each of the six colposcopists (all well trained and highly experienced), each of whom performed at least 60 colposcopies
in the study population.
at Hermanus Hospital were initially booked fortnightly from August 2008.
Measured outcomes were the excess risk of invasive cervical cancer associated with extended screening interval and the number of Pap smears and colposcopies
required to prevent 1 case of cancer with more frequent screening.
Still, HPV testing wouldn't do much to eliminate unnecessary colposcopies
: 56% of the women in the ASCUS group had a positive HPV test, and only a small number turned out to have cervical intraepithelial neoplasia (CIN) III.
New York, surveyed 294 providers: 214 colposcopy providers and BO providers who do not perform colposcopies
. The average age of the participants was 44 years.
Colposcopists who as individuals perform a small number of colposcopies
can gain knowledge from communicating between practices with the other single colposcopists through this network.