Press Releases

2002 Releases

New Approach to Cervical Cancer Screening Could Save Lives, Billions in Health Care Costs

Boston, MA--For the more than 2.5 million American women a year who get indeterminate or equivocal results from a Pap test, an automatic follow-up DNA test for the strains of human papillomavirus (HPV) that cause cervical cancer is the optimal strategy for reducing the lifetime risk of cancer at the most efficient cost to the health care system. This is the principal finding of a comprehensive policy analysis conducted by Jane Kim, MS, and Sue Goldie, MD, MPH, of the Harvard Center for Risk Analysis at the Harvard School of Public Health. The study appears in the current edition of the Journal of the American Medical Association, www.jama.com.

These indeterminate Pap test results are known as atypical squamous cells (ASC). Currently, women with these uncertain results are followed up in a variety of ways. Some are advised to return for two additional Pap tests, at six months and twelve months later. Some are advised to return for colposcopy, an examination of the cervix using a special microscope and which often involves a biopsy of the abnormal area. In some cases, ASC results are simply ignored, since very few of these women will ever develop cervical cancer. Recent studies have shown that a fourth strategy, DNA testing to look for the high-risk strains of HPV now known to cause nearly all cervical cancer, is also an effective approach.

The study by Kim and Goldie, co-authored by Dr. Thomas Wright of the College of Physicians and Surgeons at Columbia University, evaluated the clinical benefits, costs, and quality of life benefits of each of these follow-up strategies. They found that simply ignoring these indeterminate Pap test results provides less cancer risk reduction than approaches that include some kind of follow-up. Among the follow-up approaches, HPV DNA testing was more effective and less expensive than repeating the Pap test twice. HPV DNA testing was as effective as having all women undergo a colposcopic exam, but was considerably less expensive.

When caught early through a Pap test, cervical cancer is almost 100 percent preventable, with treatment of precancers. Compared with current practice, shifting women currently getting annual conventional Pap tests to a schedule of Pap tests once every three years (using a new liquid-based technology that allows for extraction of DNA from cells taken in the Pap sample), and automatically performing HPV DNA testing for women with uncertain Pap results, would provide equal protection against cervical cancer and save the health care system more than $15 billion over the lifetime of a typical group of 18 to 24 year-old women. Goldie added, "In addition to accurately identifying those women who need careful follow-up, this strategy will reduce the anxiety associated with returning for Pap smears every few months by providing women with rapid information about their risk." Some 40 to 60 percent of women with ASC Pap results do not in fact carry the high risk strains of HPV.

The research team was led by Dr. Sue Goldie, who noted, "Our analysis was done to help inform the development of the recently released national guidelines for how doctors should advise women who get abnormal Pap results." Kim is a student in the Harvard University PhD Program in Health Policy. Goldie is a faculty member in the Department of Health Policy and Management, at the Harvard School of Public Health.

For further information, please contact:

David Ropeik
Harvard Center for Risk Analysis
Phone: 617 432-6011
Cell phone 617 291-5266
Email: dropeik@hsph.harvard.edu

Dr. Sue Goldie, Assistant Professor of Health Decision Science
Harvard Center for Risk Analysis
617 432-2010, sgoldie@hsph.harvard.edu

Jane Kim
Harvard Center for Risk Analysis
617 432-0095, jkim@hsph.Harvard.edu