EVIDENCED-BASED CLINICAL MEDICINE Colposcopy: An Evidence-Based Update

Colposcopy is a diagnostic procedure, most commonly used in the diagnosis of cervical intraepithelial neoplasia and lower genital tract carcinoma. In this article, evidence-based management strategies are updated with discussion of the 2001 American Society for Colposcopy and Cervical Pathology Consensus Guidelines. Practice management issues include methods to improve cervical cancer screening rates, coding and billing, and telemedicine. Textbooks, CD-ROMs, and courses are listed for new learners and experienced providers who want to update and sharpen their skills. (J Am Board Fam Pract 2005;18: 383–92.) Worldwide, cervical cancer is the second leading cause of cancer death among women.1 Introducing cervical screening programs to areas without them results in a 60 % to 90 % reduction in cervical can-cer rates within 3 years.2 In the United States, Papanicolaou (Pap) screening has been used since the 1940s and colposcopy since the 1970s.3 Cervi-cal cancer remains the 10th leading cause of cancer death among US women with approximately 13,000 new cases and 4,100 deaths in 2002.2 This evidence-based update on colposcopy covers indi-cations, technique, management recommendations, practice management issues, and available re-sources. Indications for Colposcopy Recommendations for when to perform colposcopy have changed with the 2001 American Society fo