New Tests for Cervical Cancer Screening -- American Family Physician

www.aafp.org/afp VOLUME 64, NUMBER 5 / SEPTEMBER 1, 2001 have the greatest impact on decreasing morbidity and mortality from cervical cancer. The remaining 30 percent of cervical cancers result from errors in sampling and interpretation. Examples of such errors include incomplete sampling of the transformation zone, a poorly prepared slide with drying artifact or clumping of cells, and failure of the O ver the years, the Papanicolaou (Pap) smear has proved to be one of the most successful methods of cancer detection available. Once a common disease, invasive cervical cancer is now a relatively rare event in developed countries. Of the 13,000 women who develop cervical cancer annually in the United States, approximately 50 percent have never had a Pap smear, and another 10 percent have not had a Pap smear within five years of their diagnosis (Table 1). While the majority of these women are uninsured, nonadherence to screening recommendations has been observed even among women who have comprehensive preventive care coverage. Inappropriate triage and follow-up of an abnormal Pap smear account for 10 percent of women who develop cervical cancer. Given this information, improved access to care, adherence to screening recommendations and appropriate follow-up for women with an abnormal Pap smear should The Papanicolaou (Pap) smear has been used to screen women for cervical cancer since 1940. Recently, a number of new technologies have been developed to improve the detection of cervical cancer and its precursors. However, there is substantial controversy about whether the new tests offer meaningful advantages over the conventional Pap smear. Ideally, these new tests will increase the early detection of meaningful Pap smear abnormalities, reduce the number of unsatisfactory smears and provide fewer ambiguous results. It is also hoped that these new screening methods will not increase the number of false-positive results, but will improve the productivity of cytology laboratories without substantially increasing costs. The new tests include liquid-based/thin-layer preparations to improve the quality and adequacy of the Pap smear; computer-assisted screening methods to improve Pap smear interpretation; and new-generation human papillomavirus testing methods that may be useful in triaging patients with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions. Evidence on these new tests is reviewed and the advantages and disadvantages of their use are discussed. (Am Fam Physician 2001;64:780-6.) New Tests for Cervical Cancer Screening