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We have all heard that “screening saves lives,” but are health care providers screening for certain cancers too often?
The clinical guidelines recommend screening low-risk women for cervical cancer—with or without the complement of a human papillomavirus (HPV) test — every three years after age 30, but most primary care clinicians report they advise testing for the disease far more often, according to a report in the June 14, 2010 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Mona Saraiya, M.D., M.P.H., of the Centers for Disease Control and Prevention in Atlanta, lead author of the study, says there is no question that annual Papanicolaou (Pap) testing has helped decrease the burden of cervical cancer in the United States, according to background information in the article. But not everyone agrees that screening annually benefits low risk women.
The U.S. Preventive Services Task Force has long recommended extending screening intervals up to every three years, citing evidence that screening annually does not improve outcomes when compared with screening every three years.
Other guidelines, including those of the American Cancer Society (ACS) and American College of Obstetrics and Gynecology (ACOG), have traditionally recommended that women have three annual normal Pap tests before switching to less frequent screening. However, improved understanding of HPV infection and its cervical cancer role, along with the introduction of HPV testing, have recently resulted in stronger recommendations from ACS and ACOG to extend screening intervals without requiring prior normal Pap tests.
“Cost-effectiveness and other studies evaluating combining HPV and Pap tests in the United States and elsewhere, have concluded that lengthening screening intervals is a fundamental assumption and advantage of combining HPV and Pap testing," the authors wrote.
While combining HPV testing with cervical cancer screening may be a more precise indicator of cervical cancer risk, the researchers found doctors were still testing annually.
For the study, Saraiya and colleagues surveyed 1,212 primary care doctors—who included general practitioners, family practitioners, obstetrician-gynecologists and general internists—of whom 950 performed Pap tests and had never recommended the HPV test for their patients. The researchers used a scenario of a 35-year-old woman with no new sex partners in the last five years and a current normal Pap result and negative HPV test. They found fewer than one in five physicians (19 percent) reported they would conduct the next screening after at least three years. The majority of doctors surveyed (78 percent), said they would recommend another Pap sooner.
The findings, the authors said, suggest the recently revised guidelines haven't convinced physicians to stretch out cervical cancer screenings when incorporating HPV tests or for patients with consistently negative Pap smears. Women are being screened too often, they said, which can lead to more tests, unnecessary worry, and significantly increased health care costs with little improvement in reducing cervical cancer incidences or increasing survival rates.
In an accompanying editorial, Dr. George Sawaya, an associate professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, said that future study is needed to gain a more accurate picture of physicians' adherence to screening guidelines, and that ultimately, physicians need to be careful to find the right balance when it comes to fulfilling the oath to do no harm. To that end, he said longer intervals between screenings for low-risk women is a good place to start, and that this latest study should add to ongoing efforts to develop “rational approaches to screening.”
Lynette Summerill is an award-winning writer who lives in Scottsdale, Arizona.In addition to writing about cancer-related issues, she writes a blog, Nonsmoking Nation, which follows global tobacco news and events.
Source: Arch Intern Med. 2010;170[11]:977-986.
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June 23, 2010 - 6:38pmThis Comment