"Many women have 'abnormal' [Pap test] findings that are not cancer, but may be a 'cancer precursor.' We know that the great majority of these abnormal findings would never progress to actual invasive cancer, yet these women are referred" for further, more invasive testing, Harris said.
One such test, called a "colposcopy," [cohl-PAH-scoh-pee], involves examining the cervix for possibly cancerous lesions, followed frequently by a biopsy, i.e., taking a small sample of the lesion, which can cause pain and bleeding, as well as potential psychological harm. "The screening test itself can raise concern about dreaded cancer; a positive screening test heightens this worry; finding a cancer precursor, even one of uncertain importance, just increases worry further," they wrote.
The authors recognize the important benefit of screening for cervical and other cancers, but "screening every three years [for cervical cancer] retains about 95 percent of the benefit of annual screening, but reduces harms by roughly two-thirds." Less-frequent screening also reduces costs significantly in terms of patient and physician time and laboratory testing supplies and other resources.
The newest cervical-cancer and HPV screening recommendations were released in March 2012, too recent to have been included in the July 9 study. Women should still begin Pap tests at age 21 and every three years afterward, but women between the ages of 30 and 65 may choose to extend the Pap test interval to every five years, provided they also get an HPV test, according to the U.S. Preventive Services Task Force and the American Cancer Society, among others. However, the authors added, "the debate about a do-less approach to screeningfor cervical cancer and other conditions as wellis ongoing."
The editorial concluded: "Bob Dylan sang about changing times before they actually changed, yet
|Contact: Kathy Neal|
University of North Carolina at Chapel Hill