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Cervical cancer screening tests are often abused and study results

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Cervical cancer screening tests (Papanicolaou smears and HPV tests) are frequently abused among women with commercial insurance who are at average risk of developing cancer.

Jason Wright

The study, which included approximately 2 million women screened for cervical cancer between 2013 and 2014, found that nearly two-thirds over the next three years before the next recommended screening. I found out that I had undergone an unnecessary inspection.

“It’s not unreasonable to do more frequent tests without the potential for harm from screening,” said Jason D. Wright, associate professor of gynecologic oncology at Columbia University’s Bageros Medical Surgery University. The doctor says. Author of the study. “The problem is that overscreening has real drawbacks.”

The CUIMC Newsroom talked to Wright about what women and their healthcare providers need to know about cervical cancer screening. The following is an excerpt from our conversation:

Women with an average risk of cervical cancer do not need annual screening tests.

Cervical cancer screening methods have changed significantly over the last 10 to 15 years. Initially, screening for cervical cancer included only the annual Papanicolaou stain, which looks for abnormal cells in the cervix. The increasing popularity of this test since the 1950s is said to have dramatically reduced mortality from cervical cancer.

Twenty years ago, with the introduction of the HPV (Human Papillomavirus) test, which is much more sensitive than the Papanicolaou test, we realized that women do not need to be screened less often. In 2012, the new guidelines recommended screening with a combination of Papanicolaou stain and HPV testing, with screening intervals set every three years. And in 2020, the guidelines were further relaxed. If the HPV test is negative or the Papanicolaou smear is negative in combination with the HPV test, it should be screened again within 5 years.

Patients and healthcare providers may be hesitant to give up more frequent screening because they are worried that their risk of cancer may increase. However, the guidelines are backed by science. There are very good studies showing that screening every 3-5 years is sufficient to detect cancer in women at average risk.

Overscreening for cervical cancer can be detrimental.

With more screening, there is a much higher risk of detecting mild abnormalities that are not clinically important and are likely to resolve spontaneously. HPV is very common, and a positive HPV test does not necessarily indicate an anomaly of concern. The problem is that detection of HPV and mild anomalies often leads to more invasive procedures with unique risks, such as colposcopy and cervical conization. It also leads to unnecessary anxiety among women who are afraid that abnormal test results mean they have cervical cancer.

Another issue with overscreening is cost. Women need to take time off from work to perform more tests and procedures. And there is an economic impact on the healthcare system by performing tests that provide minimal benefit to the patient.

Women still need an annual gynecological examination.

The potential undesired consequence of reduced screening is that women may be less likely to undergo regular gynecological examinations. Our study found that 74% of women who did not undergo cervical cancer screening also did not undergo gynecological screening. In the minds of women, I think that the annual gynecological examination and cervical cancer examination are inextricably linked. But that doesn’t have to be the case.

Not having an HPV or Pap test does not require an annual gynecological examination, including pelvic examinations, often breast examinations, vaccinations and discussions about other health concerns related to the patient. It does not mean. The stage of life.

There is debate about whether women at average risk need an annual pelvic examination to look for infections, pelvic inflammatory disease, and early signs of cancer. However, doctors can also use annual gynecological examinations as an opportunity to advise patients on a variety of health concerns, from reproductive health to mental health. In addition, some women may be less likely to be screened repeatedly at the right time if they do not have an annual gynecological examination.

The guidelines are only intended to be guidelines.

Our study focused on women of average risk between the ages of 30 and 65. Some women are at high risk, including immunosuppressed women, women who have had a transplant, and women who have had abnormal tests in the past. For these women, more frequent screening is often shown.

Some women are genuinely worried about not being screened for cervical cancer each year. If so, I think it certainly makes sense to discuss the risks and benefits with the provider and come up with individual plans and strategies for screening.

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