HPV tests becoming part of cervical cancer screening

Kaiser Permanente is the first major institution to make the practice routine; critics say the added cost could make Pap tests less accessible.

By Victoria Stagg Elliott, AMNews staff. Feb. 2, 2004.

Kaiser Permanente Northern California announced in January that human papillomavirus testing would become a routine part of cervical cancer screening for women older than 30.

The hope is that the additional cost of the test will be outweighed by this result: being able to tell women who are negative on both the Pap and HPV test and that they can wait three years for their next screening. The step also would avoid colposcopies caused by the occasional false-positive.

The HMO will recommend that women who test positive for HPV continue to come in annually and receive follow-up as needed if the Pap test is also positive.

"There's concern that the women who are at the highest risk may not be detected, and the women who are at the lowest risk are still coming in dutifully every year to get their Pap smears and they probably don't need them," said Ruth Shaber, MD, director of women's health services at Kaiser Permanente Northern California. "The science and the evidence clearly shows that HPV is an excellent way of risk assessing."

But the move is controversial because of concerns about cost, counseling and maintaining women's links to the health care system.

In March 2003 the Food and Drug Administration approved a laboratory test that detects the riskiest HPV variants in cervical cells for this use. The agency previously approved the test in March 2000, but only for women with a positive Pap smear. Most medical societies now recommend that the test be an option for women, although not necessarily a standard of care. The U.S. Preventive Services Task Force says there is not enough evidence to recommend strongly either way.