New Guidelines Limit Extra Paps

New Pap test guidelines issued by a panel of experts could mean fewer return visits and less anxiety for the millions of women whose cervical cancer results come back inconclusive.

Currently, many of the estimated 2.5 million American women a year with abnormal but inconclusive results are given at least two follow-up Pap tests within a year; a colposcopy test, in which the cervix is examined and sometimes biopsied; or a test for the human papillomavirus, or HPV, the chief cause of cervical cancer.

The new guidelines say HPV testing alone should be the preferred method for many women because it is more convenient for the patient. In many cases, the HPV test can be done from the Pap test sample.

If the HPV test is negative for the riskiest forms of the virus--as it is in half of these women--the patient can be virtually assured she does not have cancer and does not need follow-up testing, the experts said.

By some estimates, that could save hundreds of millions of dollars a year in health-care costs.

The guidelines were created at a conference last year sponsored by the American Society for Colposcopy and Cervical Pathology. Participants included representatives from the American Cancer Society and the American College of Obstetricians and Gynecologists.

“It should set a standard for how women with abnormal screening tests should be handled,” said a guideline co-author, Dr. L. Stewart Massad of Chicago’s Cook County Hospital.

The guidelines appear in today’s Journal of the American Medical Assn.

They reflect doctors’ better understanding in recent years of HPV and how a few high-risk strains of the virus are the primary cause of cervical cancer.