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Am Fam Physician. 2002;65(9):1742-1752

Cervical Cancer Screening

to the editor: The debate over implementing new tests for cervical cancer screening parallels the controversy over legislating a patients' Bill of Rights for persons covered by health maintenance organizations. Proponents of both pursue questionable improvements in services that, if they materialize at all, may come at the expense of the most vulnerable segment of the population.

It is unclear whether a patients' Bill of Rights would benefit or harm the patients it appears to protect, but it is obvious that all the current proposals neglect persons without the means to obtain health care in the first place. Likewise, since the newer tests for cervical cancer screening presuppose a Papa-nicolaou (Pap) smear as an initial screen, they will provide no benefit to patients at highest risk for cervical cancer—women with inadequate health care access that seldom or never receive Pap smears.

Whereas the cost of a patients' Bill of Rights is unknown, the cost of supplementary cervical cancer screening ranges from $7,777 to $166,000 per life-year saved.1Marginal cervical cancer reductions gained from employing these expensive tests potentially displace substantial reductions in cervical cancer rates that could be achieved by using routine Pap smears to screen the uninsured.

These debates, profound in appearance, distract us from the problem at hand—providing proven, cost-effective care to the patients who need it. Let us recapture our priorities. We should turn our attention from proposing legislation and pursuing new technologies that might guard the privileged, to legislating basic health promotion and disease prevention that will protect the vulnerable.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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