Barriers to adoption of recent technology in cervical screening.

Darshana Jhala,Isam Eltoum

doi:10.1186/1742-6413-4-16

Abstract

The Pap smear is one of the modern success stories in the field of preventive medicine. Since its introduction as a screening test, there has been a dramatic reduction in the incidence of cervical cancer. However, the search for a better screening test continues. The new technologies, including liquid-based cytology (LBC), Human Papilloma Virus (HPV) testing and automated or machine-assisted screening have been introduced. However, there is continuous debate about whether society's limited resources are better spent on reaching the underserved rather than on these technologies. Another question is whether these technologies create yet another kind of disparity in delivering preventive care. For example, despite the wide use of LBC (99% of tests submitted to our laboratory are LBC), conventional Pap smears are still used to screen/follow up some women. It is not clear why some providers continue to prefer conventional smear over LBC and what are the barriers for adopting LBC in cervical cancer screening. We hypothesize the lower cost of conventional compared to LBC Pap testing, patient's lower socio-economic indices, a patient's medical history and provider's subspecialty/training all appear to play a role in the choice of using conventional Pap testing rather than LBC. Unintentionally, this choice results in repeat testing, delayed treatment and potentially higher costs than intended. The ultimate goal of this review article is to understand and explore possible barriers and disparities to adopting new technology in cancer screening.

Highlights

Evidence of superiority of liquid-based cytology (LBC) over Conventional Pap smears The accuracy of cervical cytology depends on the quality of the specimen, the preparation of the slide material, and the cytologic interpretation
Et al [17] reported that the most significant impact of LBC in their laboratory has been on the rate of unsatisfactory smears which fell from 13.9% with conventional smears, to 1.9% with LBC
The reasons for this include a decrease in unsatisfactory smears and the fact that LBC smears take less time to screen than conventional smears

Summary

Pap factors factors factors test

AFigcauursee 1and effect (fish-bone) diagram representing Walsh-McPhee Systems Model for Preventive Care A cause and effect (fish-bone) diagram representing Walsh-McPhee Systems Model for Preventive Care. System and the new guidelines for management of cervical intraepithelial lesions in 2001, the laboratory witnessed a gradual replacement of conventional Pap smear with ThinPrep® LBC (Figure 2). Year tcFDeaiedlgcCutroreeantsth2eeri,nCinythttoehleofrglayacstLtiaoFbnivooerafytceooarnrysv,eUnntiovenrasliPtyapofsmAleaabramsuabmMietd- iDecrease in the fraction of conventional Pap smear submitted to the Cytology Laboratory, University of Alabama Medical Center, in the last Five years. This data is used for clinical, cytological and histological correlation including quality control monitoring which is a continuous process as required by various accreditation agencies To investigate these observations further, we retrieved all conventional Pap smear reports issued during the period (04/05–04/06) and we determined who ordered the Pap test and from where was it ordered (place of care: VA, Children Hospital, Ob/Gyn service, Hem/Onc service, Primary Care, and others).

Percent conventional Pap smear

Findings

Total num ber of Pap tests