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Pap Tests to Spot Endometrial Cancer Recurrence Questioned


 

PALM SPRINGS, CALIF. — Routine vaginal cytology as a surveillance test for endometrial cancer recurrence is costly, inefficient, and benefits less than 1% of patients, Dr. Robert E. Bristow and his associates reported in a poster session at the annual meeting of the Society of Gynecologic Oncologists.

“The rationale for intensive surveillance of endometrial cancer patients in clinical remission is based on the premise that early detection of an asymptomatic recurrence will translate into improved survival outcomes,” the researchers, who are affiliated with the Kelly Gynecologic Oncology Service at Johns Hopkins Medical Institutions, Baltimore, wrote in their poster.

Although this premise is widely held, studies have not demonstrated a significant survival advantage for patients whose recurrences are detected during routine follow-up, compared with symptomatic patients presenting for interval evaluation, they noted.

The researchers reviewed the medical records of 377 endometrial cancer patients who were treated at the Kelly Gynecologic Oncology Service between July of 1997 and June of 2005.

They calculated the total number of Pap tests performed during surveillance or until the time of recurrence. Costs were assigned based on 2005 Pap test costs adjusted retroactively using the consumer price index.

Of the 337 patients, the majority (63.7%) had stage I cancer; 10.1% had stage II; 18.8% had stage III; and 7.4% had stage IV. The median follow-up was 30 months. A median of five Pap samples per patient were collected during the study period, for a total of 2,134 Pap tests.

The researchers found that endometrial cancer recurred in 61 patients (16.2%), while 11 (2.9%) had an isolated vaginal recurrence.

Of the isolated vaginal recurrences, seven were detected by physical examination alone, two were detected by interval computed tomography, and two asymptomatic vaginal recurrences were detected by routine vaginal cytology, for a rate of 0.5%.

“Detection of each asymptomatic vaginal recurrence required 1,067 Pap tests, generating $44,049 in cumulative charges,” the researchers noted in their poster.

They concluded that “elimination or reduction in the use of vaginal cytology for this purpose offers an opportunity for significant cost savings in gynecologic oncology health care.”

Dr. Bristow directs the Kelly Gynecologic Oncology Service.

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