Annual Pap Tests Often Ordered But Unneeded:
THURSDAY, Aug. 18 (HealthDay News) -- Many doctors continue to
recommend annual screening for cervical cancer, even though current
guidelines say some women can wait much longer between tests.
Those are the findings of a new study by Katherine Roland, a
behavioral scientist at the U.S. Centers for Disease Control and
"These findings are in conflict with the guidelines," Roland said.
The downsides of too-frequent testing, she said, include excess
costs, pain and the inconvenience of having to visit the doctor
more often than necessary.
For the study, published online Aug. 18 in the
American Journal of Obstetrics & Gynecology, Roland evaluated data from two national surveys from 2006 and found that the majority of health care providers still advised annual screenings, even when test results and a woman's history suggested it wasn't needed.
Her team also reviewed responses from 376 private office-based
health care providers and 216 providers from hospitals and
Under cervical cancer screening guidelines issued by the
American Cancer Society in 2002 and the American College of
Obstetricians and Gynecologists in 2003, women aged 30 or older
should have both a Pap test, also known as a Pap smear, and a human
papillomavirus (HPV) test, also called an HPV co-test. HPV is the
most common sexually transmitted infection, and certain types of
HPV can cause cervical cancer.
If the results of both tests are normal, a woman can wait three
years for her next Pap test, which looks for signs of cancer in
cells from a woman's cervix.
Roland presented three scenarios to the doctors and other health
care providers, each involving a woman between 30 and 60 years old
with a current normal Pap test. In one vignette, she had no current
HPV test result and a history of two normal Pap tests. In a second,
she had a current negative HPV test and two consecutive normal Pap
tests. In the third, she had a current negative HPV test and no Pap
history besides the current one.
While all three scenarios would warrant recommending an interval
of three years, most of the doctors and others who performed the
tests still would recommend yearly screening, the investigators
"We found that only half the providers are using the HPV co-test," Roland said. She couldn't explain why that is so, or why they continue to order annual screens even if they perform both tests as advised.
Among the study limitations, however, is that office staff often
answered the questions, which may have affected the accuracy, the
study authors said.
A conventional Pap test costs about $14, Roland said, and a
liquid-based cytology type test is about $28. The cost of the HPV
test varies, she noted.
The findings puzzle Dr. Elizabeth Poynor, a gynecologic
oncologist and pelvic surgeon at Lenox Hill Hospital in New York
City. "What struck me was the slow nature of the physicians to
accept the new guidelines," Poynor said.
But, she pointed out that the HPV co-test was new when the data
was collected in 2006. Today, more doctors could be using the test
and extending the interval between screenings. Maybe doctors need
to get used to the guidelines, to develop a comfort level with the
less frequent screening, she said.
The guidelines make sense, Poynor added. "When you combine a
negative HPV and a negative Pap, the false negative rate goes down
to a very low level," she said.
Women can take this information to their doctors and "use it as
a point for dialogue or discussion," Poynor suggested.
However, it's crucial to realize that the screening guidelines
apply only to women 30 to 60 who are healthy, Poynor stressed. They
don't apply to women with certain medical risk factors, such as
exposure to the prescription drug DES (diethylstilbestrol), which
has been linked to cancer.
And, it's important to tell women they still need an annual
pelvic exam, Poynor said.
To learn more about Pap testing, visit
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