Cervical cancer screening tools overused

Physicians who prefer conducting annual Pap tests as screening for cervical cancer should not test for the human papillomavirus as frequently, according to a new study.

The study, published in the June 14 Archives of Internal Medicine, said overusing these two screening tools will likely increase costs with little improvement in reducing cervical cancer or increasing survival.

In a survey of 950 physicians, researchers found that doctors tend to screen patients for cervical cancer more frequently than is recommended by three major medical organizations. When the HPV DNA test is added as a screening tool to boost sensitivity for detecting high-grade cervical precancer and cancer, even fewer physicians follow the recommended guidelines (link).

"What we're suggesting is there's nothing wrong with doing an annual Pap test ... but don't introduce another expensive test [the HPV DNA test] and then do both tests every year," said lead study author Mona Saraiya, MD, MPH, a medical epidemiologist with the Centers for Disease Control and Prevention's Division of Cancer Prevention and Control.

Researchers analyzed physicians' responses to clinical vignettes that asked the doctors to make screening recommendations. Participating in the study were general practitioners, family physicians, internists and obstetrician-gynecologists.

The first scenario detailed a 35-year-old woman with no new sexual partners in the past five years and three consecutive normal Pap results.

Researchers found 31.8% of doctors said they would recommend extending the next Pap smear to three or more years. That recommendation is in line with screening guidelines issued by the American Cancer Society, the American College of Obstetrics and Gynecology, and the U.S. Preventive Services Task Force. About one in three physicians would continue screening annually for cervical cancer.

A second scenario described a 35-year-old woman with a negative HPV test and a normal Pap test. Nineteen percent of physicians said they would extend the screening interval to three years, and 60.1% would recommend annual testing. The ACS and ACOG suggest rescreening in three years if both tests are normal. The task force does not have a recommendation on HPV testing as a primary screening test for cervical cancer.

San Francisco ob-gyn George Sawaya, MD, writing in a commentary published in the same journal issue, called the study's findings discouraging. He said the recommended screening guidelines are designed to identify women at such low risk of cervical intraepithelial neoplasia that continued annual screening could lead to more harm than benefit. The potential harms of overscreening include unnecessary follow-up testing and distress for patients.

Dr. Saraiya recommends national health agencies, such as the CDC, increase efforts to educate physicians on the recommended screening guidelines.