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Back to Gynecology Articles

Sunday, 29th February 2004


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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  HPV vaccine shown to 'substantially' reduce cervical cancer  

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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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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