I am an experienced colposcopist and teach in the areas of human papillomavirus (HPV), cervical cancer prevention, and colposcopy. I am always happy to see articles that update clinicians on the subject of cervical cancer screening, as guidelines have changed significantly in recent years and there is significant confusion among clinicians.

I found the article in the January 2016 issue of The Clinical Advisor [“Cervical cancer screening: why less is best,”] to be informative and evidence-based for readers, but I had a concern regarding the accompanying photograph of a cervix. The photo appears to be a normal cervix with a large immature transformation zone. Most cervical lesions are visible and defined, after the application of acetic acid. They have borders and degrees of acetowhitening, vessel patterns, and margins. Precancerous areas are not “dark red and puffy” as the caption suggests. While biopsy and histology is the final arbiter, this photo does not appear to represent the presence of a cervical lesion. In addition, the photo shows the cervix after the application of iodine, which obscures the presence of acetowhite lesions but does reveal immature epithelium lacking glycogen or abnormal areas lacking glycogen, and there does not appear to be a defined lesion, in this example.

I just felt a need to address this. I have been involved in reviewing colposcopy photos for educational purposes. Sometimes it is difficult to see a representation of clinical abnormalities on photos, and we try to avoid photos that are difficult to assess.—Nancy R. Berman, MSN, ANP-BC, NCMP, FAANP, Southfield, MI (212-1)

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