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Cervical cancer screening may be done too frequently in low-risk women
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Women at low risk for developing cervical cancer who had HPV cotesting were less likely to be recommended for an extended screening interval of 3 years compared with those tested with a Pap smear only.
Current ACS and American College of Obstetrics and Gynecology guidelines recommend cervical cancer screening for women aged 30 years or older 3 years after a normal Pap test result or a combined normal Pap test and HPV test.
To assess whether the addition of HPV testing would prompt primary care providers to extend screening intervals among women at low risk, researchers conducted a national survey of 1,212 providers of whom 950 performed Pap tests and recommended HPV testing.
“To balance the potential population harm incurred by women in this new surveillance category, substantial lengthening of the screening interval among low-risk women is imperative but does not appear to be occurring,” George F. Sawaya, MD, associate professor in the department of obstetrics at the University of California, San Francisco, wrote in an accompanying editorial.
For a woman aged 35 years with no new sexual partners in the past 5 years and three consecutive normal Pap test results, only 31.8% of providers reported recommending the next Pap test in 3 years or longer.
For a woman aged 35 years with normal Pap and HPV test results, 19% of physicians reported recommending the next Pap test in 3 years or longer. However, 42.8% of providers recommended not performing an HPV test at all, which is an acceptable option, according to the guidelines.
Most providers would conduct a Pap test every year, while the frequency of HPV testing varied. The volume of Pap tests ordered per month, the use of an electronic medical system and less use of a liquid-based method for screening were associated with recommending an extended screening interval. Physician specialty was also associated with recommendations.
“Overuse of screening is expensive for the health care system and may result in unnecessary follow-up testing, increased risk for colposcopy-associated morbidities and adverse birth outcomes, and distress for patients,” the researchers wrote.
For more information:
- Saraiya M. Arch Intern Med. 2010;170:977-986.