CDC Expert Commentary

Clearing Up Confusion About Cervical Cancer Screening

Mona Saraiya, MD, MPH

Disclosures

January 03, 2011

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Hello, my name is Dr. Mona Saraiya. I am a public health physician and medical epidemiologist in the Division of Cancer Prevention and Control at CDC.

As part of the CDC Expert Commentary Series on Medscape, I am speaking to you today about cervical cancer screening and the human papillomavirus (HPV) test.

As you are aware, cervical cancer is the easiest female cancer to prevent, with regular screening tests and follow-up care. Organizations in the United States that issue cervical cancer screening recommendations are:

  • The American Cancer Society (ACS);

  • The American College of Obstetricians and Gynecologists (ACOG); and

  • The US Preventive Services Task Force (USPSTF).

Most of these organizations recommend that after a series of normal annual Pap tests in women 30 years of age and older, the screening interval can be extended to 3 years. Additionally, ACS and ACOG offer the option of using the HPV test with Pap test (known as co-testing) in women 30 years of age and older. If both tests are negative, then the next screening can occur in 3 years.

The reason for this recommendation is that the risk of developing high grade cervical precancer or cancer in the next 3-5 years after a negative HPV test, let alone a negative HPV and normal Pap test, is very low.

A recent CDC study in the June 2010 issue of the Archives of Internal Medicine[1] compared physicians' use of the Pap test alone vs co-testing, to determine whether the addition of the HPV test to routine cervical cancer screening prompts physicians to extend the screening interval as recommended.

The physician sample included 950 physicians who conducted cervical cancer screening. The physicians were asked to report their screening recommendations based on a couple of clinical vignettes of two 35-year-old women with different histories.

The first was a 35-year-old woman with no new sex partners in the past 5 years and a history of 3 normal Pap test results in a row. The second was a 35-year-old woman with a normal Pap test result and a negative HPV test. In both situations, current guidelines indicate that the next screening interval should be in 3 years.

When compared with national cervical cancer screening guidelines, more physicians reported annual testing regardless of the details of the vignettes. For the 35-year-old woman with 3 normal Pap tests in a row, 1 in 3 said they would conduct the next Pap test in 3 years, and 2 in 3 said they would recommend the Pap test sooner.

For the 35-year-old woman with a current normal Pap test result and negative HPV test, fewer than 1 in 5 physicians surveyed said they would conduct the next screening after at least 3 years, and 3 in 4 physicians said they would recommend another screening sooner.

The findings suggest that the newer guidelines have not convinced physicians to lengthen the screening intervals when incorporating HPV tests for patients as part of routine screening. Women are being screened too often -- which can lead to more tests, possibly false positive tests, unnecessary worry, and increased healthcare costs.

These conclusions suggest that adding the HPV test to routine cervical cancer screening did not provide confidence to the physicians to extend the screening intervals.

The CDC, along with its professional and community partners, aims to communicate up-to-date information to providers and women about the current cervical cancer screening guidelines, taking into account their common questions such as:

  • When is it okay to use the Pap test alone?

  • When does it make sense to add another type of test to the mix?

  • Why does this mean we can screen less often with greater confidence?

I hope this information is helpful to you in your medical practice. For additional information about cervical cancer screening please see the resources listed on this page. Thank you.

Web Resources

Cancer Prevention and Control

Cervical Cancer Screening Podcast

Cervical Cancer Screening

Mona Saraiya, MD, MPH, joined the CDC as an Epidemic Intelligence Service officer in the Division of Reproductive Health in 1995 and is currently a medical officer in the Division of Cancer Prevention and Control. Since EIS, the majority of her CDC tenure has been spent with the Division of Cancer Prevention and Control focusing on cervical cancer screening and HPV testing practices. Dr. Saraiya also provides gynecologic cancer expertise as a medical officer for the Inside Knowledge: Get the Facts About Gynecologic Cancer campaign. During the past 3 years, she has been an active member in various CDC human papillomavirus (HPV) workgroups. Her cervical cancer and HPV research portfolio is vast as she recently completed an initiative to characterize the HPV-associated cancer burden in the United States. Furthermore, she has also published several articles including characterizing the incidence of cervical cancer in the United States, the necessary communication pieces for HPV testing and the HPV vaccine, and the low Pap testing rates among foreign-born women in the United States.

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