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Cervical cancer screening every 3 years after three or more normal Pap tests is a safe option

Current care guidelines recommend that Pap tests to screen for cervical cancer can be extended to once every 3 years, instead of every year, among low-risk women with three consecutive negative Pap tests. This is a safe option, given the minimal excess risk of cervical cancer associated with longer screening intervals, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS07373). The researchers found that, compared with annual screening for 3 years, screening performed once 3 years later after the last of three or more consecutive negative Pap tests in women 30 to 64 years of age was associated with an average excess risk of cervical cancer of 3 in 100,000.

To confirm the safety of this screening approach, researchers led by George F. Sawaya, M.D., of the University of California, San Francisco, determined the prevalence of biopsy-proven cervical neoplasia (new and abnormal cell growth) among 938,576 nonelderly women. They stratified the women according to the number of previous consecutive negative Pap tests. Using a model that estimates the rate at which dysplasia (abnormal cell growth) will progress to cancer, they estimated the risk of cancer within 3 years after one or more negative Pap tests.

According to the model, the estimated risk of cancer with annual Pap tests for 3 years compared with Pap tests once 3 years later after the last negative test was 2 vs. 5 in 100,000 among women 30 to 44 years of age, 1 vs. 2 in 100,000 among women 45 to 59 years of age, and 1 vs. 1 in 100,000 among women 60 to 64 years of age.

More details are in "Risk of cervical cancer associated with extending the interval between cervical-cancer screenings," by George F. Sawaya, M.D., K. John McConnell, Ph.D., Shalini L. Kulasingam, Ph.D., and others, in the October 16, 2003, New England Journal of Medicine 349(16), pp. 1501-1509.

Editor's Note: Researchers at the University of Pittsburgh recently published an article on a related topic. It shows that chronic pelvic pain after pelvic inflammatory disease is associated with reduced physical and mental health. For details, see: Haggerty, C.L., Schulz, R., Ness, R.B., and others (2003, November). "Lower quality of life among women with chronic pelvic pain after pelvic inflammatory disease." (AHRQ grant HS08358) Obstetrics & Gynecology 102, pp. 934-939.

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