Lege Artis Medicinae

[Advent reflections]

FRENKL Róbert

DECEMBER 29, 1993

Lege Artis Medicinae - 1993;3(12)

[Around Christmas, the concepts of new beginnings, peace, family... with all their positive connotations make us think. Is there a new beginning in Hungarian healthcare? There have been staff changes before. In the past, deputy ministers, today deputy state secretaries, are the better-off colleagues whose main task is to attend meetings and 'specialise', explain the inexplicable, smile and shake hands, inspire hope, knowing that there is little hope. And they chair the committees whose long, long meetings are risk-free, because no proposal becomes reality. More often than not, no proposal is made. ]

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[ From 1980 to 1991, 1379 women with abnormal colposcopic and/or cytologic findings were examined at the Department of Gynecological Oncology at the National Institute of Oncology, Budapest. The sensitivity and specificity of these screening tests were studied retrospectively. All women underwent either cervical excision or conisation. Cytological and colposcopical findings were compared with the histological findings. Sensitivity and specificity of cytology were 49% and 77%, retrospectively. The corresponding figures for colposcopy were 88% and 12%, and for cytology and colposcopy together, 96% and 14%. 1. The low sensitivity of cytology suggests that as many as 50% of CIN lesions will be missed if cytology alone is used for screening. This finding probably justifies our screening policy (i. e., colposcopy should be used as a primary tool). 2. We found 194 asymptomatic patients with carcinoma in situ, 40 with microinvasive and 8 with frank invasive carcinoma. This finding emphasizes the importance of cervical cancer screening. 3. To decrease the false positive and negative rates, the introduction of new scientific results into the every day screening practice is urgently needed. 4. Our data suggest the superiority of a colposcopical screening method to a cytological one; however histological examination must be done independently of a screening method if the suspicion of cervical dysplasia arises. ]

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