Primary care physicians can have a major impact on the diagnosis and treatment of gynecologic malignancy in elderly women.
Previous literature on the subject of Papanicolaou tests in the elderly has been confusing to physicians who must decide which screening procedures are appropriate for their patients. The study by Mandelblatt et al1 in this issue of The Journal will surely be welcome to such physicians.
Prospectively evaluating over 800 elderly women, the authors found a prevalence rate for abnormal Papanicolaou smears (ranging from cervical intraepithelial neoplasia I to invasive carcinoma) of 16 per 1000 cervices at risk. Of equal importance is the fact that 47% of potential participants either refused to have a Papanicolaou smear or did not keep the follow-up appointment scheduled for that purpose. Nonparticipants, who less frequently reported having had a hysterectomy, appeared to be at greater risk for cervical neoplasia than participants.
Also noteworthy is