1. Perils of Testing: What Happens When Tests for Cervical Cancer are Normal but HPV Testing Is Abnormal?
When nearly 10,000 women were screened with Pap tests for cervical cancer and with DNA tests for high-risk human papillomavirus (HPV), 23 percent were found to be infected with high-risk HPV regardless of status on the Pap test (Article, p. 493.)
HPV is considered the major cause of cervical cancer.
Prevalence was highest among women age 14 to 19 years. Importantly, 9 percent of women 30 years of age or older with normal Pap tests had high-risk HPV infection.
Authors say that the results of the study imply that many women older than 30 who have the DNA tests for HPV will require follow-up colposcopy, in which the physician directly observes the cervix under magnification.
An editorial writer cautions that we know very little about the risk of cervical cancer in women with a normal Pap test and a positive HPV test. Women over age 30 who agree to have both Pap testing and HPV testing should know that the results could disagree, placing them in a group whose risk of cervical cancer is unknown (Editorial, p. 557).
2. Treat Smoking As Any Chronic Disease and Reimburse for Therapy
Smoking is the leading cause of preventable death in the United States. The authors state that cigarette smoking is an addiction that should be viewed as a chronic disease, as are addictions to other substances.
Insurers pay for life-time treatment for chronic diseases such as diabetes. Medications to prevent relapse of serious addictions such as heroin (by methadone) are provided long-term. But insurance companies often do not provide reimbursement for long-term treatment with nicotine replacement therapy, an FDA-approved treatment.
If we adopt the view that tobacco dependence is a chronic condition with severe consequences and death rates higher than those of other chronic
|Contact: Susan Anderson|
American College of Physicians