Experts weigh best use of cervical cancer screens

One study examining the cost effectiveness of HPV testing and another evaluating liquid-based cytology generate further debate among physicians.

By Victoria Stagg Elliott, AMNews staff. Feb. 13, 2006.

Testing Pap smears that turn out to have "atypical squamous cells of undetermined significance" for human papillomavirus and only then referring women who have a positive result for colposcopy is a cost-effective practice, according to a study published in the Jan. 18 Journal of the National Cancer Institute.

"HPV testing identifies the largest percentage of women who need follow-up at a reasonable cost," said Shalini L. Kulasingam, PhD, lead author and assistant research professor at the Duke University Center for Clinical Health Policy Research in Durham, N.C.

But while HPV testing has become a more common part of cervical cancer screening, experts say the need for its use is far from clear-cut. Most guidelines indicate it's an acceptable option, as are colposcopy or repeat cytology, for this patient group. Still, determining cost effectiveness does not settle the question of how it should be used.

"It's a reasonable triage strategy from a cost point of view," said George F. Sawaya, MD, director of the Cervical Dysplasia Clinic at San Francisco General Hospital. "But this can be much more complicated than people appreciate."

For HPV testing to be the most cost efficient, it must be conducted on any Pap smear with certain results, and experts are concerned women might not have the opportunity to give fully informed consent.

"Since there are alternative strategies that are just as good, women should be involved in the discussion to be tested," said Dr. Sawaya, who is also an associate professor in obstetrics and gynecology at the University of California, San Francisco.