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Model highlights benefits and risks of cervical cancer screening methods
September 22, 2008In an analysis based on a computer model, it appears that comparing the benefits and risks of different cervical cancer prevention approaches may help women and their physicians choose appropriate screening strategies, according to a report in the September 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Routine screening with cervical cytologic testing, commonly known as Pap smears, is credited with reducing the incidence of cervical cancer through the early detection of abnormal cells, according to background information in the article. Today, U.S. women have an average lifetime cervical cancer risk of 0.7 percent. Recently, even more sensitive DNA testing for the human papillomavirus (HPV), which contributes to cervical cancer, has become available, along with vaccines against HPV. This leaves women and their physicians with several prevention options and considerations.
Natasha K. Stout, Ph.D., and colleagues at the Harvard School of Public Health, Boston, used a computerized simulation model of cervical cancer in the United States to assess the benefits and risks associated with various screening strategies. The strategies differed by type of primary screening test, process for handling abnormal results and screening frequency. "These strategies pose trade-offs between minimizing cancer risk (already small with regular screening) and minimizing the risk of false-positive test results and excessive diagnostic procedures," the authors write.
Differences in women's lifetime cancer risk varied little between screening strategies; however, the difference between the strategy offering the least and most frequent referrals for colposcopy (a procedure in which physicians look directly at the cervix through a microscope) was three-fold. For a representative group of 1,000 20-year-old women undergoing annual screening for 10 years, combined cytologic and HPV testing would lead to an estimated 1,795 referrals for colposcopy and other follow-up procedures (1,788 of them excessive, or not associated with cancer). The same women would receive 403 referrals (396 excessive) from cytologic testing following by triage HPV testing for those with abnormalities; 333 referrals (326 excessive) from conventional cytologic testing; and 223 referrals (216 excessive) from HPV testing followed by cytologic triage testing.
"For women who experience short-term anxiety around screening and diagnostic workup, quality of life could be an important criterion for decision making if several screening options associated with similar cancer risk reduction are available," the authors write. "Using cytologic testing followed by triage testing in younger women minimizes both diagnostic workups and positive HPV test results, whereas in older women diagnostic workups are minimized with HPV DNA testing followed by cytologic triage testing."
"There is great promise in the availability of accurate HPV diagnostics, new screening technology and HPV vaccination for successful cervical cancer prevention in the United States. From both an individual and population perspective, the range of new options for prevention will ideally be assembled in such a way as to improve cancer outcomes, reduce disparities and minimize the risk of overdetection of abnormalities likely to resolve on their own," they conclude.
"These results provide an initial step toward a comprehensive set of clinically relevant information highlighting trade-offs among screening policies to ultimately better inform women's decisions and provide additional dimensions for the construction of clinical guidelines."
JAMA and Archives Journals
Differences in women's lifetime cancer risk varied little between screening strategies; however, the difference between the strategy offering the least and most frequent referrals for colposcopy (a procedure in which physicians look directly at the cervix through a microscope) was three-fold. For a representative group of 1,000 20-year-old women undergoing annual screening for 10 years, combined cytologic and HPV testing would lead to an estimated 1,795 referrals for colposcopy and other follow-up procedures (1,788 of them excessive, or not associated with cancer). The same women would receive 403 referrals (396 excessive) from cytologic testing following by triage HPV testing for those with abnormalities; 333 referrals (326 excessive) from conventional cytologic testing; and 223 referrals (216 excessive) from HPV testing followed by cytologic triage testing.
"For women who experience short-term anxiety around screening and diagnostic workup, quality of life could be an important criterion for decision making if several screening options associated with similar cancer risk reduction are available," the authors write. "Using cytologic testing followed by triage testing in younger women minimizes both diagnostic workups and positive HPV test results, whereas in older women diagnostic workups are minimized with HPV DNA testing followed by cytologic triage testing."
"There is great promise in the availability of accurate HPV diagnostics, new screening technology and HPV vaccination for successful cervical cancer prevention in the United States. From both an individual and population perspective, the range of new options for prevention will ideally be assembled in such a way as to improve cancer outcomes, reduce disparities and minimize the risk of overdetection of abnormalities likely to resolve on their own," they conclude.
"These results provide an initial step toward a comprehensive set of clinically relevant information highlighting trade-offs among screening policies to ultimately better inform women's decisions and provide additional dimensions for the construction of clinical guidelines."
JAMA and Archives Journals
Cervical Cancer Current Events and Cervical Cancer News RSSLSUHSC public health contributes to estimate of HPV-related cancers
Professor Vivien Chen, PhD,. Associate Professor Xiao Cheng Wu, MD, PhD and Assistant Professor Edward Peters, DMD, SM, ScD, at LSU Health Sciences Center New Orleans School of Public Health contributed five papers to the largest most comprehensive assessment of the burden of human papillomavirus (HPV)-associated cancers in the United States to date.
The health burden of raising a grandchild
Precautionary health measures such as mammograms and cholesterol tests that identify the risk of heart disease are critical for the well-being of women over 50. Add the responsibility of providing sustained care for a grandchild, and these preventive examinations become even more important.
Healthy bones program reduces hip fractures by 37 percent
Proactive measures can reduce hip fracture rates by an average of 37.2 percent -- and as much as 50 percent -- among those at risk, according to a study conducted by Kaiser Permanente Southern California. The study was published online on November 3 by The Journal of Bone & Joint Surgery, a peer-reviewed journal.
New MRI technique may identify cervical cancer early
Using high-resolution magnetic resonance imaging (MRI) with a special vaginal coil, a technique to measure the movement of water within tissue, researchers may be able to identify cervical cancer in its early stages, according to a new study being published in the November issue of Radiology.
Cancer screening rates among older Medicaid patients fall short of national objectives
Only about half of Medicaid recipients age 50 and older appear to receive recommended screening tests for colorectal, breast and cervical cancer, according to a report in the October 13 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Social class dictates cancer risk
Cervical and lung cancer are more common in poor people while rates of breast cancer and melanoma are higher in the wealthy.
New HPV test for developing countries shows high accuracy in predicting cervical disease: Study
A new HPV test developed by QIAGEN specifically for use in regions of the world with scarce resources is "substantially" more accurate in identifying women with cervical disease than the current methods (Pap testing and visual inspection) in these countries.
As head and neck cancer risks evolve, more treatment options emerge
Advances in understanding head and neck cancer over the last decade have led to more treatment options and improved quality of life for patients, according to a review published this week in the New England Journal of Medicine.
Cervical cancer prevention should focus on vaccinating adolescent girls
The cost-effectiveness of vaccination in the United States against human papillomavirus (HPV), a sexually-transmitted virus that causes cervical cancer, will be optimized by achieving universal vaccine coverage in young adolescent girls, by targeting initial "catch-up" efforts to vaccinate women younger than 21 years of age, and by revising current screening policies.
Breaking the 'mucus barrier' with a new drug delivery system
Chemical engineers from Johns Hopkins University have broken the "mucus barrier," engineering the first drug-delivery particles capable of passing through human mucus - regarded by many as nearly impenetrable - and carrying medication that could treat a range of diseases. Those conditions include lung cancer, cervical cancer and cystic fibrosis, the research noted in a presentation scheduled for the 236th National Meeting of the American Chemical Society.
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