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Back to Gynecology Articles
Sunday, 29th February 2004
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The study recommended screening every 3 years as opposed to annual Pap smears
for those not at risk of cervical cancer
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In the last 30 years researchers have learned
that most cervical cancer cases are caused by a small number
of high-risk strains of HPV, while most other strains are
harmless. Adding HPV DNA tests to cervical cancer screening
allows doctors to identify if a woman has a high-risk strain
of HPV.
Adding this test could raise the cost of screening
dramatically. To evaluate cervical cancer risk and cost-effectiveness
of various cervical cancer screening strategies a team from Harvard
headed by Goldie et al. conducted a study which appears in the April
issue of
Obstetrics and Gynecology.
They used a mathematical model to simulate the
natural history of HPV and cervical cancer in a cohort of U.S. women.
Outcomes measured included cancer incidence, life expectancy, lifetime
costs, and incremental cost-effectiveness ratios.
The study showed conventional Pap smear every three
years until age 30, followed by HPV and Pap every three years after
age 30, reduced cervical cancer by 90%-92% compared with 90% with
annual Pap smear alone. In addition, the combination screening
decreased costs by 30% over annual Pap smears.
But researchers say these results do not apply to
younger women. They say screening women under 30 with an HPV test
would not be cost-effective because younger women have higher rates of
transient HPV infections. Because most HPV infections in these women
come and go without posing a risk to their health, a positive result
on an HPV test could cause unnecessary stress and treatment. The 3
year screening schedule also would not be
recommended for women at high risk of cervical cancer, such as women
with weakened immune systems.
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References
Sue J. Goldie, MD, MPH, Jane J. Kim, MS and Thomas C. Wright, MD.
Cost-Effectiveness of Human Papillomavirus DNA Testing for Cervical
Cancer Screening in Women Aged 30 Years or More. Obstet Gynecol 103:
619-631.
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