Cervical Cancer Screening-Reply
Mack T. Ruffin, MD
University of Michigan Medical Center Ann Arbor
Arch Fam Med. 1993;2(11):1114-1115.
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From Dr Ferris' letter, it is clear that I did not precisely define the phrase "clinically relevant end point or marker."1 In relation to screening for cervical cancer, the ideal, clinically relevant end point should have direct association with the detection of preinvasive cervical cancer. This implies that an instrument that delivers the cells or produces certain types of smears is more likely to detect the preinvasive cervical cancer than one that does not. The major flaw in all of the current research on cervical cancer screening collection instruments is the use of intermediate end points that have no proven association with the detection of preinvasive cervical cancer. Examples of these end points are the quality of smears or endocervical elements.
The references cited by Dr Ferris all suffer from this problem or have significant methodological problems. It is worthwhile to review these references in more detail to highlight the
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