LETTERS * CORRESPONDANCE
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors of accepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement. Seules peuvent etre retenues pour publications les lettres recues en double dont la longueur n'excede pas 450 mots. Elles doivent etre mecanographiees en qualite "correspondance" sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession du copyright. Les lettres ne doivent rien contenir qui ait ete presente ailleurs pour publication ou deja paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont detruites. Les lettres retenues peuvent etre abregies ou faire l'objet de modifications d'ordre redactionnel.
Screening for cancer of the cervix T n he report of the National Workshop on Screening for Cancer of the Cervix, which appears as a special supplement to this issue of CMAJ, presents a series of recommendations that revise and update those of the 1982 and 1976 task force. The workshop was attended by many
stakeholders, including consumers and providers. The recommendations are based on the need for laboratory services of high quality and an information management system that allows compliance and the frequency of screening to be monitored. The undersigned societies, as significant providers of health care to women, have reviewed the -
For prescribing information see page 1384
report and collaboratively prepared this response. The development of formal screening programs in Canada is appropriate to reduce the incidence and rate of death from cancer of the cervix and is strongly supported as a primary goal. It is essential that the recommendations of the workshop be considered as a whole and not be implemented in part until such comprehensive programs exist within each province. This is clearly stated as the primary recommendation of the report; since it is the basis on which the other recommendations are made the importance of this first step cannot be overstated. The screening interval of every 3 years after satisfactory results from two Papanicolaou smears was selected after a detailed analysis of the available data; it can only be justified if a mechanism is in place to ensure strict patient compliance and optimal laboratory services. However, there is still a concern that this prolonged window may allo'v a slight increase in the cumulative risk of more aggressive malignant disease developing in individual
patients.
rather than colposcopic examination. The recommendations of the national workshop are supported as a whole. National and provincial health care agencies should be strongly encouraged to review the report and ensure that they have high-quality laboratory services and patient information systems. Until such facilities are in place routine screening at annual intervals should be a continued standard of practice in all women who have been sexually active. Gavin C.E. Stuart, MD Chair, Oncology Committee Society of Obstetricians and Gynaecologists of Canada Greg O'Connell, MD Secretary-treasurer Gynaecologic Oncologists of Canada Alex Ferenczy, MD President Society of Canadian Colposcopists
Physical inactivity among physicians I t is not at all surprising that Paul H. Gaertner and Drs. Whitmer B. Firor and Lindsay Edouard (Can Med Assoc J 1991; 144: 1253-1256) found physicians to be less physically active than the general population, despite their awareness of the importance of exercise. The authors hypothesized that the high demands and time constraints placed on medical students contribute to their inability to take part in recreational activities. I suggest that the lack of encouragement for pursuing physical fitness during medical training also contributes to physician
The practice of recommending repeat smear tests without colposcopy for patients showing lowgrade squamous intraepithelial lesions (the first grade of cervical intraepithelial neoplasia [CIN I]) is subject to question, since there are conflicting data about the natural history of this abnormality and the risk of progression to invasive carcinoma. Also of concern are the anxieties that this approach engenders among patients and the uncertain economic inactivity. Students at McMaster Uniimpact of repeat cytologic tests CAN MED ASSOC J 1991; 145 (10)
1195
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors of accepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement. Seules peuvent etre retenues pour publications les lettres recues en double dont la longueur n'excede pas 450 mots. Elles doivent etre mecanographiees en qualite "correspondance" sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession du copyright. Les lettres ne doivent rien contenir qui ait ete presente ailleurs pour publication ou deja paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont detruites. Les lettres retenues peuvent etre abregies ou faire l'objet de modifications d'ordre redactionnel.
Screening for cancer of the cervix T n he report of the National Workshop on Screening for Cancer of the Cervix, which appears as a special supplement to this issue of CMAJ, presents a series of recommendations that revise and update those of the 1982 and 1976 task force. The workshop was attended by many
stakeholders, including consumers and providers. The recommendations are based on the need for laboratory services of high quality and an information management system that allows compliance and the frequency of screening to be monitored. The undersigned societies, as significant providers of health care to women, have reviewed the -
For prescribing information see page 1384
report and collaboratively prepared this response. The development of formal screening programs in Canada is appropriate to reduce the incidence and rate of death from cancer of the cervix and is strongly supported as a primary goal. It is essential that the recommendations of the workshop be considered as a whole and not be implemented in part until such comprehensive programs exist within each province. This is clearly stated as the primary recommendation of the report; since it is the basis on which the other recommendations are made the importance of this first step cannot be overstated. The screening interval of every 3 years after satisfactory results from two Papanicolaou smears was selected after a detailed analysis of the available data; it can only be justified if a mechanism is in place to ensure strict patient compliance and optimal laboratory services. However, there is still a concern that this prolonged window may allo'v a slight increase in the cumulative risk of more aggressive malignant disease developing in individual
patients.
rather than colposcopic examination. The recommendations of the national workshop are supported as a whole. National and provincial health care agencies should be strongly encouraged to review the report and ensure that they have high-quality laboratory services and patient information systems. Until such facilities are in place routine screening at annual intervals should be a continued standard of practice in all women who have been sexually active. Gavin C.E. Stuart, MD Chair, Oncology Committee Society of Obstetricians and Gynaecologists of Canada Greg O'Connell, MD Secretary-treasurer Gynaecologic Oncologists of Canada Alex Ferenczy, MD President Society of Canadian Colposcopists
Physical inactivity among physicians I t is not at all surprising that Paul H. Gaertner and Drs. Whitmer B. Firor and Lindsay Edouard (Can Med Assoc J 1991; 144: 1253-1256) found physicians to be less physically active than the general population, despite their awareness of the importance of exercise. The authors hypothesized that the high demands and time constraints placed on medical students contribute to their inability to take part in recreational activities. I suggest that the lack of encouragement for pursuing physical fitness during medical training also contributes to physician
The practice of recommending repeat smear tests without colposcopy for patients showing lowgrade squamous intraepithelial lesions (the first grade of cervical intraepithelial neoplasia [CIN I]) is subject to question, since there are conflicting data about the natural history of this abnormality and the risk of progression to invasive carcinoma. Also of concern are the anxieties that this approach engenders among patients and the uncertain economic inactivity. Students at McMaster Uniimpact of repeat cytologic tests CAN MED ASSOC J 1991; 145 (10)
1195
