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Title: Model Highlights Benefits and Risks of Cervical Cancer Screening Methods
URL: http://www.pslgroup.com/dg/22D3D6.htm
Doctor's Guide
September 22, 2008

CHICAGO -- September 22, 2008 -- In an analysis based on a computer model, it appears that comparing the benefits and risks of different cervical cancer prevention approaches may help physicians choose appropriate screening strategies, according to a study in the September 22 issue of Archives of Internal Medicine.

Natasha K. Stout, PhD, and colleagues at the Harvard School of Public Health, Boston, Massachusetts, used a computerised 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 minimising cancer risk and minimising 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 was 3-fold.

For a representative group of 1,000 women aged 20 years undergoing annual screening for 10 years, combined cytologic and human papillomavirus (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 minimises both diagnostic workups and positive HPV test results, whereas in older women diagnostic workups are minimised with HPV DNA testing followed by cytologic triage testing.

"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," the authors conclude.

SOURCE: Archives of Internal Medicine

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