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False-negative Papanicolaou smears not only endanger the patient's life, but may also lead to legal problems for the clinician. The PAPNET interactive computerized system has been shown to reduce the false-negative rate in the author's laboratory, and disclosed the presence of atypical or cancerous cells in prior false-negative smears in a number of patients with invasive carcinoma.

Pelvic examinations, including a Papanicolaou smear of the uterine cervix, were performed on 403 asymptomatic, sexually active adolescent girls aged from 12 to 16 years who were in a youth detention center in New York City. The smears were negative for precancerous abnormalities in 389 girls, but 168 of these had evidence of inflammation or nonspecific atypia. In the remaining 14 smears there was cytologic evidence of early precancerous changes (low-grade cervical intraepithelial neoplasia). The prevalence rate for early neoplastic changes was 35/1,000, far higher than previously reported. Further evaluation of three of these girls, by colposcopy and biopsy, revealed precancerous epithelial abnormalities of varying degrees of severity in two of them. Since all patients screened were sexually active and were asyptomatic, no clinical feature distinguished the 389 with negative cytology from the 14 with intraepithelial neoplasia. Five of the patients with precancerous cellular abnormalities had histories of sexual activity of less than two years. The data suggest that cervical cytologic screening should be incorporated into the routine examination of sexually active female adolescents.

Occult endometrial carcinoma is a detectable disease using commercially available sampling devices and cytohistologic techniques. A cohort of 2586 asymptomatic women (98% past the age of 45, 78% caucasian) was screened. Of these women, 1567 were screened twice, and 187 were screened three times. The prevalence and incidence rates of endometrial carcinoma, as defined in the present study, including four missed cases, were 6.96 per 1000 and 1.71 per 1000 women years, respectively. The prevalence rate was 7.38 per 1000 for caucasian women and 5.40 per 1000 for women of other races. An epidemiologic evaluation suggested that the onset of menopause past the age of 49 was the only statistically significant risk factor, whereas race, parity, estrogen intake, and obesity, as calculated by the Quetelet index, were not statistically significant. The present study strongly suggests that in asymptomatic women past the age of 50, endometrial hyperplasia does not necessarily precede or accompany the development of endometrial carcinoma. Two distinct mechanisms may be responsible for the onset of endometrial cancer: endometrial hyperplasia occurring in the symptomatic and younger woman; and endometrial adenocarcinoma occurring ab initio in the older patient.

Study of the prevalence rates of uterine cervical carcinoma in situ among women attending centres of Planned Parenthood of New York City, Inc., showed a small but statistically significant difference between the population choosing and using the diaphragm and the population choosing and using oral steroids for contraception. This can be attributed either to a decreased prevalence rate for women using the diaphragm or to an increased rate for women using oral steroids. The reason for the difference is not apparent from these data.