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Comment and Response |

Accurately Estimating Cervical Cancer Screening Overuse Among Older Women

David T. Liss, PhD1,2; David W. Baker, MD, MPH1,2,3
[+] Author Affiliations
1Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
2Center for Advancing Equity in Clinical Preventive Services, Northwestern University Feinberg School of Medicine, Chicago, Illinois
3Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Intern Med. 2013;173(13):1266. doi:10.1001/jamainternmed.2013.6846.
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To the Editor In their recent article, Kale and colleagues1 use data from the 1999 and 2009 National Ambulatory Medical Care Survey (NAMCS) and the outpatient component of the National Hospital Ambulatory Medical Care Survey (NHAMCS) to analyze trends in overuse and misuse of health care services. They report that between 1999 and 2009, the rate of ordering cervical cancer screening at study visits declined from 3.1% to 2.2%. These findings belie the fact that cervical cancer screening among women 65 years and older remains extremely common and highly problematic. Because this study reported cervical cancer screening orders at single visits, it gives the spurious impression that such testing is unusual. Even if we account for the fact that elderly patients typically make multiple outpatient visits per year, Kale and colleagues’ estimated rate of annual screening seems far too low.

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July 8, 2013
Minal S. Kale, MD, MPH; Alex D. Federman, MD, MPH; Salomeh Keyhani, MD, MPH
1Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York
2Division of General Internal Medicine, University of California, San Francisco3San Francisco Veterans Affairs Hospital, San Francisco, California
JAMA Intern Med. 2013;173(13):1266-1267. doi:10.1001/jamainternmed.2013.7408.
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