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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.


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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