Single-visit screen-and-treat approach explored. (High-Grade Cervical Lesions).

NEW ORLEANS -- A single-visit screen-and-treat approach in patients found to have high-grade cervical lesions is feasible and virtually eliminates loss to follow-up, results of a prospective, randomized trial suggest.

Of 1,993 demographically similar women recruited from underserved, inner-city areas, 977 were randomized to the single-visit arm of the study, and 1,016 were treated with usual care. High-grade cervical lesions were detected in 10 patients in the single-visit program, and 2 of those (20%) declined treatment at the time of detection and were considered lost to follow-up; high-grade lesions were detected in 11 patients in the usual-care program and 6 .of those (55%) were lost to fob low-up, Dr. Alberto Manetta reported at the annual meeting of the Society of Gynecologic Oncologists.

Patients in both groups were interviewed to obtain demographic information before evaluation, and then each underwent a pelvic examination and Pap smear. Patients in the usual-care group were discharged following the examination and test and were later notified of their results.

Women in the single-visit group were asked to remain at the clinic while Pap smears were sent by courier--in batches of three--to a laboratory for staining and reading. The lab reports were faxed back to the clinic, and patients with normal results were discharged, while those with high-grade squamous intrapithelial lesions, atypical glandular cells of undetermined significance, or suspicion of carcinoma--with the exception of the two patients who declined treatment--underwent cervical diathermy loop excision without colposcopic examination.

The two patients who declined treatment and were considered lost to followup both were. evaluated in the first month of treatment. Their refusal of: treatment was most likely a result of ...