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Doctors Too Pap-Happy, Survey Suggests

MONDAY, April 8 (HealthDay News) -- Most primary care physicians advise women to get "Pap" tests for cervical cancer screening more often than clinical guidelines recommend, new research reveals.

Guidelines recommend that women aged 30 or older with a negative test result for the potentially cancer-causing human papillomavirus (HPV) and a normal Papanicolaou (Pap) test wait three years before getting another Pap test.

However, after surveying almost 2,100 doctors, researchers led by Zahava Berkowitz of the U.S. Centers for Disease Control and Prevention found most advise that women get another Pap test even sooner.

"From 2006 to 2009, primary care providers consistently reported that they would recommend Papanicolaou testing sooner than recommended by guidelines, especially after normal co-testing results," the authors wrote in a research letter published online April 8 in JAMA Internal Medicine.

When a woman undergoes a Pap test, cells scraped from her cervix are examined under a microscope to check for precancerous abnormalities.

In an accompanying journal editorial, Dr. Nancy Morioka-Douglas and Dr. Paula Adams Hillard, of the Stanford University School of Medicine in California, argued that performing Pap tests on women younger than 21 and women who have had a total hysterectomy for a benign condition poses clear risks with no proven advantage.

The annual cost of Pap tests in these women is an estimated $850 million, they noted in a journal news release. "For specific high-risk populations, including women with a history of cervical cancer or high-grade cervical lesions, those who were exposed to diethylstilbestrol [DES] in utero, and those who are immunocompromised or HIV-infected, screening may be appropriate," the editorialists concluded.

Another expert said he is inclined to agree. In response to their argument, Dr. Michael LeFevre, of the University of Missouri, Columbia, wrote in a separate journal editorial, "Leaving costs out of the debate, the case that the use of Papanicolaou tests in women in these clinical situations results in more harm than good is compelling."

More information

The U.S. Centers for Disease Control and Prevention has more about cervical cancer screening.

-- Mary Elizabeth Dallas

SOURCE: JAMA Internal Medicine, news release, April 8, 2013

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