Additional tips for surgical resection of endometriosis … and more

First, she stated that the latest guidelines from ASCCP recommend both cytology and testing for human papillomavirus (HPV) “to determine the optimal interval between screening tests and for triage to colposcopy.” She cited an interim guidance document. In fact, ASCCP does not recommend any screening modality. ASCCP has developed guidelines for management of abnormal screening tests,¹ but it relies on other organizations, such as ACOG, the American Cancer Society, and the US Preventive Services Task Force to guide clinicians on screening intervals and methods. We recognize that co-testing with a Pap test and a validated HPV DNA test is a viable option, but Pap testing alone using conventional or liquid-based methods remains acceptable.

Second, Dr. Kupets argues that, among issues in cervical cancer screening that “need to be resolved,” is the follow-up protocol for women who test positive for HPV 16 or 18. In fact, ASCCP published guidance on that issue in its 2007 Consensus Guidelines: Such women merit immediate colposcopy, whereas women who test positive for high-risk HPV DNA but who are HPV 16/18 negative should have a Pap and HPV DNA test in 1 year, with colposcopy if either is positive.¹

L. Stewart Massad, Jr, MD
Professor of Obstetrics and Gynecology
Division of Gynecologic Oncology
Washington University School of Medicine
St. Louis, Mo

“Noninvasive test identifies more than 98% of Down syndrome cases”
JANELLE YATES (NOVEMBER 2011)

Even a low false-positive rate for Trisomy 21 is too high

I would like to see the MaterniT21 Down syndrome assay undergo rigorous screening in the low-risk population before I use it. I also have reservations about the fact that other tests continue to be needed to provide information on Trisomy 18 and open neural tube defects.

As long as there is a false-positive rate with the new test—however small—there is concern that a normal pregnancy might be terminated.

Tirun Gopal, MD
Allentown, Pa

End of Down syndrome would be a sad affair

I have never met a child with Down syndrome I did not like. I have never met a child with Down syndrome who didn’t like everyone he or she met. It is no wonder that, in classical literature, children who have Down syndrome are referred to as the Clowns of God, a term of endearment, due to their genuine affection, joy, and love for others, and their desire to please. It is with unbelievable sadness that I continue to see our specialty society on a search-and-destroy mission for these most innocent of children.

Allan T. Sawyer, MD, MS
Glendale, Ariz

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