The Role of Human Papilloma Virus Testing in Cervical Cancer Prevention

Molly C. Fey, FNP, MSN; Margaret W. Beal, CNM, PhD


J Midwifery Womens Health. 2004;49(1) 

In This Article

Cervical Cancer Screening

The Pap test was designed to detect precancerous cellular changes known as dysplasia. A direct relationship has been established between the percent of a population screened and declines in cervical cancer incidence and mortality.[12] An individual's risk of developing cervical cancer is 2 to 10 times higher among those who have never been screened and increases with the length of time since a woman's last cervical smear.[2] Pap screening is widespread in the United States and currently recommended for all women who are sexually active or age 18 and over.[11]

Despite the success of cytologic evaluation, cervical cancer has not been eradicated, and benefits of screening have reached a plateau.[40] Roughly half of all cervical cancers arise in women who were adequately screened.[41] The rate of false-negative Pap tests is estimated to be as high as 25% to 50%.[42] Mean sensitivity of the conventional Pap test in populations with low prevalence of abnormalities is only 58%.[43] This is attributable to poor sample collection, incorrect slide preparation, and laboratory interpretation errors.[2,44] Inadequate sampling occurs in 5% to 10% of all Pap tests, and it is estimated that only 20% of harvested cells are actually transferred to the slide. Sensitivity is further hindered if cells are incorrectly transferred or preserved.[1,2,12] Interpretation of cytologic irregularities is subjective and poorly reproducible, even among expert cytologists.[15,17] Poor specificity is also of concern, with false-positive rates of up to 15%.[1] Conventional smears have a low positive predictive value for high-grade pathology and high potential for misclassification. Equivocal and mildly irregular Pap results have a low yield of underlying high-grade pathology and present great costs in referral and follow-up.[40,42] Epidemiological data suggest that current methods of Pap screening are unlikely to prevent more than 60% of cervical cancers in a population.[45]


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