Human papillomavirus testing, vaccination, and gynecologic screening: fight or flight?

The implementation of cervical cancer screening programs beginning in the 1950s is largely credited with a more than 70% reduction in cervical cancer deaths in the United States. In the decades since the introduction of these programs, the annual or biennial Papanicolaou (Pap) test has gained widespread acceptance by patients and clinicians as part of required preventive health care for women. However, advances in knowledge of the pathogenesis of cervical neoplasia have resulted in more advanced and accurate testing modalities related to human papillomavirus (HPV) testing and, most recently, in the development of vaccines for the prevention of infection by the most common oncogenic types of HPV. The integration of these testing modalities and vaccines into patient care will have profound effects on the current and future practice of gynecologic cytol-ogy. Although the exact scope of these effects is not yet fully understood, the primary result, regardless of the technology, will most likely be a significant reduction in the number of Pap tests performed annually in the United States. Cytopathology professionals need to prepare for the outcomes of this evolution in cervical cancer prevention and patient management. Preventive Services Task Force each published revised guidelines for cervical cancer screening related to the onset, cessation , and frequency of Pap test screening. 1 Although there is some variation among these guidelines, they can be summarized as follows: 1. Screening should begin 3 years after the onset of sexual activity or by the age of 21 years, whichever occurs first. 2. Cessation of screening can occur at the age of 65 or 70 years with documentation of 3 negative Pap test results within the preceding 10 years. 3. Screening should occur every 2 to 3 years; for women 30 years and older who have dual screening with the Pap test and HPV testing, a screening interval of 3 years is appropriate if the results of both tests are negative. 4. Screening is not recommended for women after hysterectomy, except in patients who had the procedure because of cervical neoplasia. Even without new technologies, simple adherence to the current recommended screening guidelines would cause a decrease in Pap test volumes when compared with annual screening. Solomon et al 1 used data from multiple National Health Interview Surveys and the US Census Bureau to estimate Pap test volumes in the United States over time. They then analyzed those data and concluded that adherence to …