Cervical Cancer: Should Women be Tested Less Often?

Research reveals it is not likely that physicians will reduce the frequency of cervical cancer screening, even with the use of the human papilloma virus test (HPV) and vaccine.   

 You can’t blame them, especially since “Cervical cancer continues to kill approximately 4,900 women annually out of the 15,700 women who are annually diagnosed with new cases of cervical cancer” according to the American Society of Cytopathology in their Journal, Pathology Patterns Reviews.  Additionally, in a newsletter published by the Mayo Clinic “Living with Cancer”, it states “the symptoms of cervical cancer are negligible and don’t usually manifest until later stages of the disease”.

 Symptoms, which are easily masked by hormonal changes during child bearing, as well as pre and post menopausal years, include, but are not limited to:

Vaginal bleeding after intercourse, between periods or after menopause

Watery, bloody vaginal discharge that may be heavy and have a foul odor

Pelvic pain or pain during intercourse

With use of the HPV DNA test and just one normal Pap test, the American Cancer Society and American College of Obstetrics and Gynecology have now recommended screening intervals every three years.

 The June 14, 2010 issue of Archives of Internal Medicine, Mona Saraiya, MD, MPH, of the CDC and her colleagues reveal that the HPV DNA test is more reliable in the detection of high-grade cervical pre-cancers and cancers when compared to the Pap test, thus allowing doctors to determine which women may be at low risk of developing high-grade cervical pre-cancer and cancer for the next 10 years.

 Researchers conducted a survey of 1,212 physicans, Ob/Gyns, general internists, and family ractitioners, finding that overall, 82% recommended HPV testing following an abnormal Pap test.  Only about 28% recommended co-testing with HPV.

 For a 35 year old woman with three normal Pap test results, more OB/Gyns said they would recommend another Pap test in one year.  However, for a 35 year old woman with a normal Pap test and a negative HPV test, more OB/Gyns  would recommend another Pap test in three years. 

 Researchers reported that “for Internists and family practitioners the addition of a negative HPV test result seemed to offer less security in recommending extension to triennial screening than a history of three previous normal pap test results and no new sexual partners."  Additionally, "the most likely explanation for the changes by specialty may be lower familiarity with HPV and HPV testing guidelines among [internists] and [family practitioners], as found in other studies.”

"Given the endorsement of an extension of screening intervals with HPV co-testing by two major guideline-setting organizations five years before our survey was fielded," researchers were surprised that cervical cancer testing continues to be an annual recommendation by most doctors.

Perhaps another side of this debate should be considered in regard to medical malpractice claims regarding Pap tests and cervical cancer.

An article published by the American Society of Cytopathology in their Journal, Pathology Patterns Reviews, states, “The number of claims made involving Pap smears represents, at best, a very small percentage of the total number of false-negative cases which have, in fact, resulted in needless delays in diagnosis and treatment and resultant excess morbidity. This is obvious when one considers that the false-negative rate of a single Pap smear is widely quoted to be 20%.”

 Dr. Koss asserted that “invasive cancer is rarely preceded by truly negative serial Pap smears when available for the 2 to 3 years prior to the diagnosis of invasive cancer being made.” 

 In a litigious society, and accompanied with wanting the best health care for their patients, it isn’t surprising that most doctors adhere to an aggressive screening regimen for cancer.