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Widespread use of Pap tests to screen for cervical cancer has led to a dramatic decline in U.S. cervical cancer deaths over the last several decades. Yet, despite recently revised screening guidelines designed to minimize harms resulting from overtesting, obstetricians/gynecologists continue to overscreen low-risk women, according to a study supported in part by the Agency for Healthcare Research and Quality (HS07373). For instance, the American Cancer Society (ACS) suggests that screening start within 3 years of the onset of sexual activity or age 21 and be less frequent than annually in women over age 30 who have had three or more previous normal Pap tests.
The ACS also endorses cotesting for human papillomavirus, which is associated with cervical cancer, and discontinuing screening in certain women. The American College of Obstetricians and Gynecologists has recently made similar recommendations. Researchers from the University of California, San Francisco, and Kaiser Permanente examined responses to questionnaires sent to 355 randomly selected U.S. obstetricians/gynecologists. The questions were structured as clinical vignettes.
Contrary to guidelines, 74 percent of the 185 eligible respondents (mostly private practice/managed care physicians) said they would begin screening girls who were not yet sexually active at age 18. Sixty percent of respondents said they would continue annual screening in a 35-year-old woman with three or more normal tests. Also, frequent screening was common in women after total hysterectomy for symptomatic fibroids and no history of dysplasia (abnormal cells) and in 70-year-old women with a 30-year history of previous normal tests.
Vigilant screening is commendable. Yet, the resources spent toward overzealous screening in low-risk populations and the harms incurred by false-positive tests (for example, due to invasive followup procedures) deserve attention, conclude the researchers.
More details are in "Current cervical neoplasia screening practices of obstetricians/gynecologists in the US," by Mona Saint, M.D., M.P.H., Ginny Gildengorin, Ph.D., and George F. Sawaya, M.D., in the February 2005 American Journal of Obstetrics and Gynecology 192, pp. 414-421.
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