Number of referrals, diagnostic workups varied with cervical cancer screening approaches

With the advent of new screening and vaccination technologies for cervical cancer, women’s personal preferences have begun to play a large role in their decision-making regarding prevention strategies.

Researchers at Harvard School of Public Health assessed the benefits and potential risks associated with various cervical cancer prevention approaches. They employed a variety of outcomes, including colposcopy referrals and incidence of cervical intraepithelial neoplasia.

Colposcopy referrals and diagnostic workups varied threefold. Screening with combined cytologic and HPV testing led to the most referrals, whereas HPV testing followed by cytologic triage led to the fewest. Diagnostic rates of CIN types 2 or 3 were similar, and 95% of positive screening test results were for mild abnormalities — those likely to resolve without intervention.

Using cytologic testing followed by triage testing in younger women reduced the number of diagnostic workups as well as positive test results for HPV. However, in older women, diagnostic workups were minimized with HPV DNA testing followed by cytologic triage testing. – by Rebekah Cintolo

Arch Intern Med. 2008;168:1881-1889.

This is an interesting and well-done study conducted to examine the important issue of the relative benefits of several cervical cancer screening strategies, both from the perspective of third-party payers as well as the individual woman being screened. The results highlight the fact that there is no single "correct" answer to this issue, and much depends on the relative value one places on a greater risk of false-positive vs. false-negative test results in this arena. Finally, the discussion of a level of uncertainty associated with these valuable tests serves to emphasize the utility of HPV vaccination.

– Mauri Markman, MD

HemOnc Today Editorial Board member