Aggressive Approach to Cervix Abnormalities Questioned

One study finds early colposcopy no more cost-effective than regular surveillance
By Jane Parry
HealthDay Reporter

WEDNESDAY, July 29 (HealthDay News) -- The benefits of referring women for immediate colposcopy or aggressive treatment instead of cytological surveillance following detection of low-grade cervical abnormalities may not outweigh the risks of overtreatment, according to three related studies from the Trial Of Management of Borderline and Other Low-grade Abnormal smears (TOMBOLA) published online on July 28 in BMJ.

Julian Little, Ph.D., of the University of Ottawa, and colleagues conducted a study of 4,439 women aged 20 to 59 with borderline nuclear abnormalities or mild dyskaryosis, of whom 2,223 were screened every six months while 2,216 were referred for colposcopy, and found that while colposcopy was better at detecting more severe disease, it was also associated with more serious after effects and for longer periods of time.

Linda Sharp, Ph.D., of the National Cancer Registry in Cork, Ireland, and colleagues compared the outcomes of immediate large loop excision or up to four punch biopsies in women with borderline cervical abnormalities and found that detection rates were similar in both groups and that large loop excision resulted in more bleeding and discharge, while David K. Whynes, Ph.D., of the University of Nottingham in the United Kingdom, and colleagues conducted a cost analysis of various screening options and found that no one method was more cost-effective than the others.

"Further analyses and secondary economic evaluations of the TOMBOLA data may help policy makers fully appreciate the evidence from this landmark study," writes the author of an accompanying editorial.

Some members of the TOMBOLA group reported receiving grants and other financial aid from MSD Sanofi Pasteur and GlaxoSmithKline in relation to human papillomavirus and cervical cancer.

Abstract - Little
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Abstract - Sharp
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Abstract - Whynes
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