Journal of the American Medical Association

January 21, 1998

Automated Pap Smear Screening May Be Cost-Prohibitive

CHICAGO, IL -- January 20, 1998 -- A new device that uses computers to analyze Pap smears only

slightly increases the accuracy of detecting abnormal results at a cost of 20 to 30 times more than

traditional testing methods, according to an article in tomorrow's issue of The Journal of the American

Medical Association (Timothy J. O'Leary et al., "PAPNET-Assisted Rescreening of Cervical Smears,"

JAMA 239, pp. 235-237.)

Timothy O'Leary, M.D., Ph.D., of the Armed Forces Institute of Pathology in Washington, D.C., and

colleagues evaluated the accuracy and cost-effectiveness of an automated device called Papnet, which

was recently approved by the United States Food and Drug Administration. Papnet was used to

rescreen 5,478 Pap smears, which had previously been identified as normal, from female service members.

The researchers determined that using Papnet over manual rescreening methods found only one more

abnormal Pap smear for every 913 cases. Papnet also yielded only one more diagnosis of the sexually

transmitted disease human papillomavirus (HPV) for every 2,739 cases rescreened.

The researchers estimate rescreening with Papnet would cost $33,781 for each abnormal Pap smear

identified and $101,343 for each HPV identified, compared to $1,065 and $4,970, respectively, for

manual rescreening.

Pap smears, tests used to detect abnormal changes in the cells of the cervix, are used to detect cervical

cancer and some sexually transmitted diseases. Sample cells are collected during a pelvic examination

and are usually sent to a laboratory for examination under a microscope. Papnet and other automated

systems aim to reduce the significant number of false-negative results of laboratory manual screening, the

authors write.

However, given the high costs of using the automated system, the researchers suggest other ways to

reduce cervical cancer death, such as implementing more effective screening programs like performing

Pap smears on women who do not currently get them.

"This statistically valid study of thousands of cases demonstrates a very slight improvement in quality

produced by use of this automated device," said George Lundberg, M.D., editor of JAMA. "But such

use produced costs greatly in excess of traditional methods. "These results suggest that a prudent health

care system would not apply this device for widespread use in our current cost-conscious environment."