Should U.S. Women Be Screened for Cervical Cancer With Pap Tests, HPV Tests, or Both?
Authors: Rebecca B. Perkins, Elizabeth A. Stier
Journal: Annals of Internal Medicine (2014)

Ideas and Opinions19 August 2014Should U.S. Women Be Screened for Cervical Cancer With Pap Tests, HPV Tests, or Both?Rebecca B. Perkins, MD, MSc and Elizabeth A. Stier, MDRebecca B. Perkins, MD, MScFrom Boston University School of Medicine, Boston, Massachusetts.Search for more papers by this author and Elizabeth A. Stier, MDFrom Boston University School of Medicine, Boston, Massachusetts.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-1043 Annals Author Insight Video - Rebecca B. Perkins, MD, MSc In this video, Rebecca B. Perkins, MD, MSc, offers additional insight into her Ideas and Opinions piece, "Should U.S. Women Be Screened for Cervical Cancer With Pap Tests, HPV Tests, or Both?" SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Papanicolaou (Pap) test, introduced in the 1940s by Dr. George Papanicolaou, is considered one of the greatest achievements in women's health. Population-wide Pap testing reduces cervical cancer deaths by 80%, and many women and physicians consider the Pap test to be the cornerstone of preventive care (1). However, it has relatively low sensitivity, especially for adenocarcinomas, and results are often poorly reproducible; thus, women must be tested frequently to reduce cancer risk. In the 1990s, Dr. Harald zur Hausen and colleagues recognized that human papillomavirus (HPV) causes nearly all cervical cancer (1). This discovery led to significant advances in ...References1. Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, et al; American Cancer Society. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol. 2012;137:516-42. [PMID: 22431528] CrossrefMedlineGoogle Scholar2. Schiffman M, Solomon D. Findings to date from the ASCUS-LSIL Triage Study (ALTS). Arch Pathol Lab Med. 2003;127:946-9. [PMID: 12873166] CrossrefMedlineGoogle Scholar3. Murphy J, Kennedy EB, Dunn S, McLachlin CM, Fung Kee Fung M, Gzik D, et al. HPV testing in primary cervical screening: a systematic review and meta-analysis. J Obstet Gynaecol Can. 2012;34:443-52. [PMID: 22555137] CrossrefMedlineGoogle Scholar4. Nanda K, McCrory DC, Myers ER, Bastian LA, Hasselblad V, Hickey JD, et al. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review. Ann Intern Med. 2000;132:810-9. [PMID: 10819705] LinkGoogle Scholar5. Mayrand MH, Duarte-Franco E, Rodrigues I, Walter SD, Hanley J, Ferenczy A, et al; Canadian Cervical Cancer Screening Trial Study Group. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007;357:1579-88. [PMID: 17942871] CrossrefMedlineGoogle Scholar6. Sankaranarayanan R, Nene BM, Shastri SS, Jayant K, Muwonge R, Budukh AM, et al. HPV screening for cervical cancer in rural India. N Engl J Med. 2009;360:1385-94. [PMID: 19339719] CrossrefMedlineGoogle Scholar7. U.S. Department of Health and Human Services. Brief Summary of the Microbiology Devices Panel Meeting—March 12, 2014. Accessed at www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/MicrobiologyDevicesPanel/UCM389192.pdf on 25 April 2014. Google Scholar8. Dillner J, Rebolj M, Birembaut P, Petry KU, Szarewski A, Munk C, et al; Joint European Cohort Study. Long term predictive values of cytology and human papillomavirus testing in cervical cancer screening: joint European cohort study. BMJ. 2008;337:a1754. [PMID: 18852164] CrossrefMedlineGoogle Scholar9. Katki HA, Kinney WK, Fetterman B, Lorey T, Poitras NE, Cheung L, et al. Cervical cancer risk for women undergoing concurrent testing for human papillomavirus and cervical cytology: a population-based study in routine clinical practice. Lancet Oncol. 2011;12:663-72. [PMID: 21684207] CrossrefMedlineGoogle Scholar10. Zhao C, Li Z, Nayar R, Levi AW, Winkler BA, Moriarty AT, et al. Prior high-risk human papillomavirus testing and Papanicolaou test results of 70 invasive cervical carcinomas diagnosed in 2012: results of a retrospective multicenter study. Arch Pathol Lab Med. 2014. [PMID: 24694342] MedlineGoogle Scholar11. Gertig DM, Brotherton JM, Budd AC, Drennan K, Chappell G, Saville AM. Impact of a population-based HPV vaccination program on cervical abnormalities: a data linkage study. BMC Med. 2013;11:227. [PMID: 24148310] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Rebecca B. Perkins, MD, MSc; Elizabeth A. Stier, MDAffiliations: From Boston University School of Medicine, Boston, Massachusetts.Acknowledgment: The authors thank Dr. L. Stewart Massad for his review of the manuscript and insight into the benefits and limitations of cervical cancer screening options.Grant Support: By American Cancer Society Mentored Research Scholar Grant (MRSG-09-151-01).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1043.Corresponding Author: Rebecca B. Perkins, MD, MSc, Boston University School of Medicine, 85 East Concord Street, 6th Floor, Boston, MA 02118; e-mail, [email protected]edu.Current Author Addresses: Drs. Perkins and Stier: Boston University School of Medicine, 85 East Concord Street, 6th Floor, Boston, MA 02118.Author Contributions: Conception and design: R.B. Perkins, E.A. Stier.Analysis and interpretation of the data: R.B. Perkins, E.A. Stier.Drafting of the article: R.B. Perkins, E.A. Stier.Critical revision of the article for important intellectual content: R.B. Perkins, E.A. Stier.Final approval of the article: R.B. Perkins, E.A. Stier.Collection and assembly of data: R.B. Perkins, E.A. Stier.This article was published online first at www.annals.org on 10 June 2014. PreviousarticleNextarticle Advertisement Annals Author Insight Video - Rebecca B. Perkins, MD, MSc In this video, Rebecca B. Perkins, MD, MSc, offers additional insight into her Ideas and Opinions piece, "Should U.S. Women Be Screened for Cervical Cancer With Pap Tests, HPV Tests, or Both?" FiguresReferencesRelatedDetails Metrics Cited byComparative assessment of test characteristics of cervical cancer screening methods for implementation in low-resource settingsShould Self-Sampling Be an Option for Women in the United States?Cost-Effectiveness of Primary HPV Testing, Cytology and Co-testing as Cervical Cancer Screening for Women Above Age 30 YearsMolecular Detection of Human Papillomaviruses 19 August 2014Volume 161, Issue 4Page: 295-297KeywordsAtypical squamous cellsCancer preventionCancer screeningCervical cancerCervical cancer screeningDysplasiaHigh grade squamous intraepithelial lesionsHuman papillomavirusSpecificityTreatment guidelines ePublished: 19 August 2014 Issue Published: 19 August 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...