Many American women who engage in preventive health measures make annual appointments with their gynecologists for a check-up and screening tests, including the Papanicolaou (Pap) test for cervical abnormalities. A new study said most doctors give the Pap test far too often and aren’t following the recommended guidelines.
The Pap test is used to detect premalignant and malignant (cancerous) cells in order to prevent and treat cervical cancer. It was invented by and named after the prominent Greek doctor Georgios Papanicolaou and is an adaptation of the procedure used to screen and detect anal cancers.
Clinical guidelines recommend screening low-risk women for cervical cancer every three years after age 30. (High-risk women - such as those with a weakened immune system or those with previous cervical abnormalities - should be screened more frequently.)
Most primary care clinicians report they would advise testing more frequently, according to a report in the June 14 issue of Archives of Internal Medicine. Adding a test for human papillomavirus (HPV) to screening protocols does not increase clinicians' adherence to guidelines.
The study's findings are that cost-effectiveness models "suggest that the practice patterns we found...are likely to increase costs with little improvement in reducing cervical cancer 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," the authors wrote.
"Many physicians reported overscreening women by using both the HPV and Pap tests annually. Until measures are in place to reinforce extended screening intervals among women with negative HPV and normal Pap test results, there is no advantage gained with HPV co-testing, and it is more expensive."
Annual Pap testing has helped decrease the level of cervical cancer in the United States, according to background information in the article. The U.S. Preventive Services Task Force - citing evidence that screening annually does not improve outcomes when compared with screening every three years - has long recommended extending screening intervals up to every three years. Other guidelines, including those of the American Cancer Society (ACS) and American College of Obstetrics and Gynecology (ACOG) traditionally have recommended that women have three annual normal Pap tests before switching to less frequent screening.
Recently, improved understanding of HPV infection and its role in cervical cancer, along with tests for HPV, have resulted in stronger recommendations from ACS and ACOG to extend screening intervals without requiring prior normal Pap tests.
"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," the authors wrote.
Mona Saraiya, M.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues surveyed 1,212 primary care physicians, of whom 950 performed Pap tests and had recommended the HPV test for their patients. The clinicians—who included general practitioners, family practitioners, obstetrician-gynecologists and general internists—were asked to report their screening recommendations in response to clinical vignettes.
More information:
Cervical Cancer Screening With Both Human Papillomavirus and Papanicolaou Testing vs Papanicolaou Testing Alone: What Screening Intervals Are Physicians Recommending? Archives of Internal Medicine 2010;170[11]:977-986 http://archinte.ama-assn.org/
http://wellness.blogs.time.com/2010/06/14/are-doctors-screening-for-cervical-cancer-too-often/
http://www.medpagetoday.com/OBGYN/GeneralOBGYN/20679
http://latimesblogs.latimes.com/booster_shots/2010/06/most-docs-dont-follow-screening-guidelines-for-cervical-cancer-add-in-hpv-and-its-even-worse.html