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Obstetrics and Gynecology

Edward C. Hill, MD
JAMA. 1986;256(15):2068-2070. doi:10.1001/jama.1986.03380150078017.
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Of the various gynecologic concerns that will most directly influence interaction between the primary care physician and patient during the next few years, three have been selected for review as most timely and relevant.

The incidence of invasive cancer of the cervix and the death rate from this malignancy have been steadily declining during the past 25 years. This trend is due, in large measure, to the early detection and treatment of cervical dysplasia and carcinoma in situ. These precursor lesions, being invisible to gross inspection, are discovered primarily by means of regular, routine Papanicolaou-Traut smears of the cervix. In the past, annual Papanicolaou smears have been routine, this interval having been chosen rather arbitrarily. Whenever such regular examinations are widely used, drastic reductions in cervical cancer mortality rates occur.1,2

In 1980, the American Cancer Society,3 on the basis of a report of a Canadian task force on


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