New guidelines for managing women with abnormal pap smears

May 21, 2002

Each year, approximately 3.5 million women in the United States have an abnormal Pap test that requires some form of further evaluation or treatment. This week's issue of the Journal of the American Medical Association (JAMA) contains new national consensus guidelines designed to help guide clinicians of all subspecialities to better evaluate women whose Pap tests suggest they may have cervical cancer or abnormal cells that may lead to cervical cancer.

"It is expected that the consensus guidelines will become widely adopted in the United States and aid in the standardization of care of women with all types of abnormal Pap tests," says Dr. Thomas C. Wright, lead author of the consensus guidelines, associate professor of pathology at Columbia University College of Physicians & Surgeons, and associate attending physician in pathology at NewYork-Presbyterian Hospital.

The American Society for Colposcopy and Cervical Pathology (ASCCP) sponsored the guidelines and worked with representatives from 29 national organizations and federal agencies involved in women's health care. These experts evaluated medical literature from the past decade and used the results of the $25 million National Cancer Institute's ongoing clinical trial of more than 5,000 women with abnormal Pap tests when developing the guidelines.

Dr. Edward J. Wilkinson, chairman of the ASCCP Consensus Guidelines Conference, says, "These are the most comprehensive recommendations ever published for women with abnormal Pap tests." The guidelines describe how best to utilize new technologies including liquid-based cytology and DNA testing for human papillomavirus (HPV), a sexually-transmitted virus that is the primary cause of cervical cancer. Dr. J. Thomas Cox, a co-author and ASCCP committee chairman for the guidelines, says, "We're excited that the consensus guidelines have incorporated the new technologies and define for the practicing clinician both when to--and when not--to use them."

One of the important recommendations in the guidelines addresses women with the most common type of abnormal Pap test, an inconclusive result referred to as ASC-US or atypical squamous cells of undetermined significance. Before these guidelines, women with ASC-US would usually get either several repeat Pap tests or undergo a colposcopy, during which the cervix is examined using a special type of microscope and biopsies are taken. The new guidelines say the other approaches may still be used, but HPV testing is preferred whenever liquid-based Pap tests are employed. If the liquid test is used, the laboratory can test the same sample used for the original Pap test for HPV, eliminating the need for a repeat doctor visit.

The test quickly reassures women who are HPV negative they are unlikely to have cervical cancer and that they simply need regular annual Pap tests and it identifies those women who are HPV positive and need further evaluation.

For most women with more serious abnormalities on their Pap test, the guidelines recommend colposcopy and find HPV testing has no role. The colposcopy recommendation is an important change since previously many of these women were simply followed with repeat Pap tests.

JAMA is making the 2001 Consensus Guidelines available for free to both clinicians and patients at

Columbia University Medical Center

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