Data Provide New Insights Into the When and How of Cervical Screenings

Research has emerged validating and confirming the recommendations of the American Congress of Obstetricians and Gynecologists, the American Cancer Society, and the American Society for Colposcopy and Cervical Pathology to screen women for cervical cancer every 3 years if they have a negative human papillomavirus (HPV) test and a normal Pap test. However, the researchers also found that Pap testing was important among women who tested positive for HPV since it helped identify women who developed cancer or precancer. The data were presented at the 2011 Annual Meeting of the American Society of Clinical Oncology (ASCO).

Dr Hormuzd A. Katki, from the division of cancer epidemiology and genetics at the National Cancer Institute, and colleagues conducted this first large-scale, real world study in collaboration with Kaiser Permanente Northern California. The women (N = 331,818) were 30 years and older and were enrolled in Kaiser’s cotesting program between 2003 and 2005; follow-up was conducted through 2009. The researchers found that women who had negative HPV tests had half the risk of developing cancer as compared to those women with normal Pap tests (3.8 per 100,000 vs 7.5 per 100,000). Furthermore, while abnormal cytology greatly increased risk for cervical intraepithelial neoplasia grade 3 (CIN3+) at the 5-year mark for HPV-positive women (12% vs 5.9%), the researchers did not find the same for HPV-negative women (0.86% vs 0.16%).

“Among women who tested HPV-negative, the Pap test did not provide any additional information on their risk, but for women who tested HPV-positive, there was an additional 600 women who were found to have cervical cancer or precancer if they tested positive on the Pap test,” Katki said during the presentation. In their study population, this could have resulted in a 95% decrease in the number of Pap tests performed.

However, he also noted that Pap testing was useful for women who were HPV-positive. “For HPV-positive women, a positive Pap test identified an additional 6 in 100 women at risk for cervical cancer or precancer over 5 years,” Katki explained. “For HPV-positive women, abnormal Pap tests help identify immediate disease, whereas a normal Pap test signifies that cancer, if it occurs, is more likely to develop in the future.”

Katki told attendees: “These results suggest that an HPV-negative test result alone could be enough to give a high level of security for extending the testing interval to every 3 years, but we’ll need additional evidence from routine clinical practice and formal recommendations from guideline panels before that can be routinely recommended.”

More Information

CDC: Cervical Cancer Screening NCI: Screening and Testing to Detect Cervical CancerRelated Content

Optical Coherence Tomography Identifies Cervical CancerEducational Tutorial: Management Dilemmas in Cervical Cancer

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References

Katki HA, Kinney WK, Fetterman B.Cervical cancer risk for 330,000 women undergoing concurrent HPV testing and cervical cytology in routine clinical practice. 2011 ASCO Annual Meeting, Abstract 1508. J Clin Oncol. 29:2011; (suppl; abstr 1508).
O’Rourke K.Study challenges cervical screening guidelines HPV test trumps Pap test for cervical cancer. Infectious Disease. 2011; 1.
Goodman A.2011 ASCO Annual Meeting: 3-Year Screening Interval Safe for Women with HPV-negative and Normal Pap Tests, Data Show. The ASCO Post. 2011; 2(9).