Adding test for cervical cancer raises costs: study

Using two screening tests for cervical cancer does little to ensure that doctors will follow guidelines for less-frequent screening in low-risk women, and adding a second test increases health costs, U.S. researchers said on Monday.

They said many doctors report screening women too often, giving annual tests with both the traditional pap smear and the more sensitive DNA test for the human papilloma virus that causes cervical cancer.

One possible advantage of HPV testing is that it might give doctors confidence to wait until every three years to screen women at low risk of cervical cancer, as recommended by the U.S. Preventive Services Task Force, a federal advisory panel.

Dr. Mona Saraiya and colleagues at the U.S. Centers for Disease Control and Prevention in Atlanta wanted to see if that was the case.

“Our study using a large, nationally representative survey is, to our knowledge, one of the first to examine whether the addition of HPV testing to routine screening for cervical cancer would prompt primary care providers to extend screening intervals among women considered to be at low risk for developing precancer or cancer in the next 3 years,” the team wrote in the Archives of Internal Medicine.

They surveyed 1,200 doctors to see how often they tested women, looking specifically at the impact of adding HPV tests to the mix. They found a consistent pattern of overscreening.

“Many physicians reported overscreening women by using both the HPV and Pap tests annually,” Saraiya and colleagues wrote.

The team asked doctors to give their screening recommendations according to different hypothetical patient vignettes.

For example, for a 35-year-old woman with no new sex partners in the past five years and three normal pap test results, 32 percent of doctors surveyed said they would recommend the next pap test in three years and 33 percent said they would recommend one the next year.

Adding the HPV test appeared to make things worse.

For a 35-year-old woman with one normal pap test and a normal HPV test, 19 percent of doctors said they would extend screening to three years, while 60 percent said they would recommend annual testing.

Adding the HPV testing to cervical cancer screening is likely to increase costs “with little improvement in reducing cervical cancer incidence and increasing survival,” the researchers said.

“Overuse of screening is expensive for the health care system and may result in unnecessary follow-up testing, increased risk of colposcopy-associated morbidities and adverse birth outcomes and distress for patients.”

Until measures are in place to ensure that doctors screen women at recommended intervals, “there is no advantage gained with HPV co-testing, and it is more expensive,” the team said.

Cervical cancer is the second most common cancer in women, with 500,000 new cases each year worldwide. More than half of women with cervical cancer will die, according to the World Health Organization.

SOURCE: Archives of Internal Medicine, June 14, 2010.

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