Choosing a screening method for cervical cancer: Pap alone or with HPV test

Karen Smith-McCune, M.D., Ph.D., of the University of California, San Francisco, writes: "The updated guidelines leave physicians and other clinicians with a question: is cotesting with Pap-plus-HPV testing truly preferred over Pap testing alone (the American Cancer Society/the American Society of Colposcopy and Cervical Pathology/the American Society of Clinical Pathology recommendation), or are the options equivalent (the U.S. Preventive Services Task Force recommendation)?"

"Once a straightforward process, screening for cervical cancer is now increasingly complex. Absent better data about the advantages and disadvantages of Pap testing and cotesting in various settings, clinicians should help their patients make individual decisions about cervical cancer screening that incorporate their values and preferences. The designation of cotesting as the preferred approach in one set of screening guidelines may be premature," Smith-McCune concludes.

(JAMA Intern Med. Published online May 5, 2014. doi:10.1001/jamainternmed.2014.1368. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Dr. Smith-McCune made conflict of interest disclosures, including that she is the founding chair of the Clinical and Scientific Advisory Board and holds stock options in OncoHealth Inc., which is developing diagnostic tests for cervical cancer and other cancers associated with HPV. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Sarah Feldman, M.D., M.P.H., of Harvard Medical School, Boston, writes: "Women in the United States are cared for in private offices, public health clinics, and other diverse settings, with different tests and resources for cervical cancer screening. Thus, obtaining more evidence about a variety of cost-effective approaches to screening and surveillance should be a priority."

"Furthermore, as HPV testing becomes an option separate from cotesting, new screening and surveillance strategies should be studied in as many diverse settings as possible. Although the [American Society for Colposcopy and Cervical Pathology] guidelines for the management of abnormal cervical cancer screening tests are well intentioned, they should and can be simplified. Guidelines that are easy to implement in clinical practice help clinicians avoid mistakes and optimize patient care," Feldman concludes.

(JAMA Intern Med. Published online May 5, 2014. doi:10.1001/jamainternmed.2014.576. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Dr. Feldman is paid to write chapters for UptoDate, a peer-reviewed online textbook. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Media Advisory: To contact author Karen Smith-McCune, M.D., Ph.D., call Elizabeth Fernandez at 415-514-1592 or email Elizabeth.Fernandez@ucsf.edu . To contact author Sarah Feldman, M.D., call Lori J. Schroth at 617-525-6374 or email ljschroth@partners.org. A podcast with the authors will be available on the JAMA Internal Medicine homepage http://bit.ly/1bjKKa8 when the embargo lifts.