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This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.
A 72-year-old woman has had an annual Papanicolaou (Pap) smear with normal findings (Figure 1) for the past 30 years. She finds it difficult to undergo pelvic examinations because she has severe arthritis in her hips and vaginal atrophy. She has not been sexually active since the death of her husband 10 years earlier, and she wants to know whether
The Clinical Problem
Strategies and Evidence
Areas of Uncertainty
When to Begin Screening
When to End Screening
Frequency of Screening
Newer Methods of Screening
Guidelines
Conclusions and Recommendations
Source Information
From the Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco (G.F.S., A.E.W.); the University of California, San Francisco–Stanford Evidence-based Practice Center, San Francisco (G.F.S., A.E.W., A.M.G.); the Department of Health Administration, University of Toronto, Toronto (A.D.B.); and the Veterans Affairs Palo Alto Health Care System and Center for Primary Care and Outcomes Research, Stanford University, Palo Alto, Calif. (A.M.G.).
References
This article has been cited by other articles:
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