Clinicians May be Screening for Cervical Cancer Too Often

Annual Pap testing has helped reduce the burden of cervical cancer in the U.S. Citing evidence that screening annually does not improve outcomes when compared with screening every three years, the U.S. Preventive Services Task Force has long recommended screening intervals up to every three years.

A recently improved understanding of HPV infection and its role in cervical cancer, along with HPV tests, have resulted in stronger recommendations from the American Cancer Society and American College of Obstetrics and Gynecology to extend screening intervals without requiring normal Pap tests.

The authors claim, “Cost-effectiveness and other studies evaluating HPV co-testing [combining HPV and Pap tests] in the United States and elsewhere have concluded that lengthening screening intervals is a fundamental assumption and advantage of HPV co-testing.”
 
Mona Saraiya, M.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues surveyed over 1,200 primary care physicians, of whom 950 had performed Pap tests and had recommended the HPV test for their patients. The clinicians-who included general practitioners, family practitioners, obsetrician-gynecologists and general internists-were asked to report their screening recommendations.

For a 35-year-old woman with no new sex partners in the past five years and three normal Pap test results, nearly 32 percent of clinicians reported they would recommend the next Pap test in three years and 31 percent would recommend the next Pap test in one year. However, for a 35-year-old woman with only one normal Pap test and a normal HPV test, 19 percent of clinicians would extend the screening interval to three years, whereas 60 percent would recommend annual testing.
 
 The authors believe that cost-effective models for testing “suggest that the practice patterns we found in our study are likely to increase costs with little improvement in reducing cervical incidence and increasing survival. Overuse of screening is expensive for the health care system and may result in unnecessary follow-up testing, increased risk of colposcopy-associated morbidities and adverse birth outcomes and distress for patients.”