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Special Report: A Checkup on Women's Health

New Tool Boosts Cervical Cancer Detection

Disease: Speculoscopy illuminates abnormal cells during pelvic exams. Used with Pap smear, method has 90% success rate.

May 03, 1999|JANE E. ALLEN | TIMES HEALTH WRITER

An illuminated wand used along with the Pap smear to screen for cervical cancer or precancerous conditions is giving a small but growing number of doctors and nurses the power to identify potentially abnormal cells during pelvic examinations.

With the new method, called speculoscopy, they swab the cervix with diluted vinegar, then shine the Speculite, a chemically activated light source. It's similar to the plastic light wands that fans hold aloft at rock concerts--only brighter--and attaches to the speculum in the examination.

Under Speculite's glow and the chemical action of vinegar, normal cells appear dark blue or purple; abnormal cells look white.

With speculoscopy, a doctor or nurse can quickly diagnose a potential problem requiring follow-up because any whitish area stands "right out," says Dr. Stewart Lonky, chief medical officer of Trylon Corp. The Torrance-based company developed, manufactures and markets the screening tool as PapSure.

Proponents say studies show that the Pap smear, which yields results after cervical cells are analyzed in a laboratory, picks up about 40% of all diseases of the cervix. Adding speculoscopy boosts the rate to 90%, early studies have found. Pap smears alone detect 85% to 90% of cervical cancers. Lonky says PapSure didn't miss any cancers in 12,900 screenings.

"We believe that when a woman goes to see a doctor, she wants to know, 'Do I have cancer, do I have anything that has a possibility of developing into cancer?' To that extent, the Pap smear is less than 50% capable of getting you the right answer. PapSure is 90% sure."

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Whether speculoscopy will become widely used in the fight against a disease responsible for 5,000 annual deaths remains to be seen. With 15,000 cases diagnosed each year, cervical cancer is the No. 8 malignancy among American women.

PapSure costs $25, about as much as the accompanying Pap smear. But, unlike the Pap, it isn't covered by health insurance.

"We don't care," said Lonky. If women "truly can't afford it, we have to find ways to make it available to them and we'll go out of our way to do that."

The FDA approved speculoscopy in late 1995. Although it was to be marketed by pharmaceutical giant Pharmacia & Upjohn, it languished until this year, when Trylon reclaimed the rights. PapSure is available in 85 Southern California practices and the Women's Health Care Center at UC Irvine Medical Center.

Doctors at USC Women and Children's Hospital in Los Angeles will launch a study next month to see if PapSure improves detection in clinic patients.

"We have a population at high risk," said Dr. Erika Banks, assistant professor of obstetrics and gynecology. USC serves many Latinas, who statistically have higher rates of cervical cancer and infection, with the sexually transmitted human papilloma virus linked to most cancerous changes of the cervix.

UCLA-Olive View Medical Center--also with a high-risk population--and UCLA Medical Center should begin studies this summer, said Dr. Jonathan S. Berek, UCLA's chief of gynecological oncology.

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PapSure won't replace colposcopy, the high-magnification examination usually accompanied by a biopsy after Pap smears find questionable cells. Colposcopy, which can cost about $200, is more specific because it categorizes cell changes as mild, moderate, severe or precancerous.

For all the talk of refinements, Berek says any screening discussion must address the central fact that nearly two-thirds of the women who die of cervical cancer "have either never had a Pap smear or haven't had one in five years" because of financial or cultural barriers to screening.

Dr. Steven Vasilev, chief of gynecological oncology at Kaiser Permanente Medical Center in Los Angeles and a PapSure advisory board member, says adding PapSure to the traditional Pap smear can provide peace of mind.

"If you have a negative Pap and negative speculoscopy, you're 99% sure there's nothing there." Therefore, he said, low-risk patients--those with one sexual partner or those who are not sexually active--might feel better about having a Pap smear every three years, the standard for some insurance companies, instead of annually.

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