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.
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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