When using Pap and human papillomavirus (HPV) tests together to screen women for cervical cancer, clinicians are more likely to test the patient more frequently than national guidelines recommend.
Investigators conducted a nationwide survey of 1,212 primary-care physicians to explore whether the addition of HPV testing to routine screening for cervical cancer would prompt the practitioners to extend screening intervals among women who are considered to have a low risk of developing precancer or cancer over the next three years (Arch Intern Med. 2010;170:977-986). The U.S. Preventive Services Task Force (USPSTF) recommends extending the Pap test screening interval to up to three years. Although the USPSTF has not yet recommended HPV testing, the general rationale for adopting HPV cotesting is that the screening interval can be extended when this sensitive test yields negative results.
Among 950 providers who gave Pap tests and recommended the HPV test for screening or management, 31.8% said they would conduct the next Pap test in three years for a 35-year-old woman with three normal results. However, only 19% would conduct the next Pap test in three years if a 35-year-old woman had a normal test result and a negative HPV test finding. Most of the remaining respondents said they would conduct the Pap test more frequently.
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“Recommended extension of the screening interval to three years is actually lower when HPV cotesting is considered,” wrote the authors. “In addition, many physicians reported overscreening women by using both the HPV and Pap tests annually.”
The investigators concluded that until measures are put in place to reinforce extended screening intervals for women with negative HPV and normal Pap test results, HPV cotesting offers no advantage and is more expensive. n
