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Benefits and Risks Affect Cervical Cancer Screening

Lifetime risk for cervical cancer does not change with different screening strategies, but risk for invasive testing does

THURSDAY, Sept. 25 (HealthDay News) -- Among women who regularly screen for cervical cancer, lifetime risk is similar among differing screening approaches, but differences in referral for invasive work-up are significant, researchers report in the Sept. 22 issue of the Archives of Internal Medicine.

Natasha K. Stout, Ph.D., of the Harvard School of Public Health in Boston, and colleagues utilized an empirically calibrated simulation model of cervical cancer in the United States to assess the benefits and potential risks associated with several different screening strategies. Outcomes included colposcopy referrals, cervical intraepithelial neoplasia (CIN) types 1 and 2 or 3, life expectancy (quality-adjusted) and lifetime cancer risk.

The investigators found that colposcopy referrals and diagnostic work-ups varied by more than threefold across the testing methods, even though rates of CIN 2 or 3 were similar and most positive screening results represented mild abnormalities likely to resolve on their own. The researchers report that diagnostic work-ups can be decreased for younger women by use of triage testing after cytologic testing, and for older women by use of cytologic triage testing after HPV DNA testing.

"Although differences in a woman's lifetime cancer risk associated with alternative screening approaches are small, the difference in colposcopy referrals is threefold. Combined screening with two tests, cytologic testing and HPV DNA testing, leads to the highest number of false-positive results and excessive referrals across all screening frequencies, even when restricted to women older than 30 years," the authors write.

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