U.S. Food and Drug Administration has approved new technologies for cervical cancer screening.
ThinPrep is an automated slide preparation system for Pap smears. Samples are collected differently, stored in fluid rather than on a slide and sent to an out-of-town laboratory for evaluation, says Solveig Locke, a nurse practitioner with Mid-Atlantic Women's Health in Hagerstown. She says the process is more expensive than a regular Pap test, and she's not sure how much of the cost health insurers are covering. If the test can find abnormal cells more accurately, treatment costs would be reduced, Locke adds.
ThinPrep is the most promising of the new technologies coming out, says Dr. David H. Solberg, a gynecologist and obstetrician in practice in Hagerstown. Initial data indicate that the process is better able to pick up on abnormalities.
ThinPrep works by removing "garbage" that may be present in the sample - blood, inflammation, mucus, bacteria - says Dr. John Newby. He says Washington County Health System is looking at acquiring a ThinPrep machine for its Hagerstown laboratories. He's talking to local gynecologists to see what they think and to see if this community will bear the additional expense of the testing.
AutoPap and PapNet are computerized rescreening methods.
Newby cited an Armed Forces Institute of Pathology study of PapNet reported in the Jan. 21 issue of American Medical Association. The study concluded that this automated device found only a few more abnormalities than were found by manual rechecking under the microscope and at much higher cost.
In 1992, largely as a result of charges of shoddy practices of Pap smear labs processing large numbers of tests without careful monitoring, Congress enacted Clinical Laboratory Improvement Amendments of 1988. Law now dictates that no cytotechnologist can read more than 100 slides in a 24-hour period.
Newby says the upper limits of the number of slides read by a cytotechnologist at Washington County Health System laboratories is about 80.
Maryland is one of two states in the U.S. - New York is the other - that requires annual proficiency testing of gynecologic cytologists. This means that there is an annual check on the people reading Pap smears in Maryland, Newby says.
Another Maryland law offers protection to women, according to Dr. Lynn Rider, a Hagerstown gynecologist. Last year the legislature passed a bill that entitles women to visit an obstetrician/gynecologist for care that is medically necessary, including, but not limited to, care that is routine. This includes a Pap test and pelvic exam, Rider says.
Women no longer have to go through a health maintenance organization's primary-care physician.