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Screening with colposcopy in a prepaid health center.

The early detection of cervical cancer by widespread application of the Papanicolaou (Pap) smear has produced a decrease in U.S. mortality rates from this disease. Colposcopy is a useful adjunct in evaluating patients with an abnormal Pap smear. The author's five years of experience using the colposcope for primary screening detected 146 patients with cervical lesions, 30 with moderate dysplasia or worse and 116 with minimal or mild dysplasia. Estimated incidence by type of appointment showed the highest incidence of significant pathology (approximately one lesion per 115 patients) in patients who were seen without appointments. In 19 patients their disease would have been missed by routine Pap smear but was detected by the colposcope. Gynecologists who are trained in the use of this instrument should use it in conjunction with the Pap smear to help detect pathology in new patients.