Does the system of Papanicolaou test nomenclature affect the rate of referral for colposcopy? A survey of family physicians
J. Melnikow, A. Sierk, S. Flocke and C. A. Peters
Department of Family Medicine, University of California, Davis, Sacramento.
OBJECTIVE: To determine whether a new system of Papanicolaou test
nomenclature (the Bethesda system) or other physician variables influence
recommendations for colposcopy and biopsy for women with borderline to
moderately abnormal Papanicolaou test results. We hypothesized that
physician demographic and practice variables, in addition to Papanicolaou
test nomenclature, would influence recommendations for colposcopy. DESIGN:
A survey was mailed to a random sample of 510 active members of the
American Academy of Family Physicians. PARTICIPANTS: Three hundred
thirty-five (66%) of the eligible physicians responded, representing all 50
states. Of those in active practice, 78% were in private practice, with a
mean age of 44 years and a mean time in practice of 10 years. Ninety-three
percent of respondents in active practice performed Papanicolaou tests.
MAIN OUTCOME MEASURE: Rates of recommendation for colposcopy and biopsy in
response to abnormal Papanicolaou test reports framed by a single clinical
scenario. RESULTS: Physicians recommended colposcopy more often when the
Bethesda nomenclature system was used to describe the results of the
Papanicolaou test. These differences were significant for four specific
Papanicolaou smear pairs. Inclusion of recommendations for further
evaluation strongly influenced physicians to recommend colposcopy. In
multivariable analyses, demographic and practice variables were not
associated with recommendations for colposcopy. CONCLUSIONS: The Bethesda
system of nomenclature, when compared with a traditional descriptive
nomenclature system, influenced family physicians to recommend colposcopy
and biopsy more often for abnormal Papanicolaou test results presented in a
clinical scenario. Greater utilization of technology and higher medical
care costs may result from use of the Bethesda system. Guidelines for
evaluation of abnormal Papanicolaou test results are needed for use in
conjunction with the Bethesda system guidelines for Papanicolaou test
reports.
