Patients with Abnormal Pap Smears Should Receive Immediate Testing for HPV

Consensus Guidelines: Patients with Abnormal Pap Smears Should Receive Immediate Testing for HPV

According to the American Society for Colposcopy and Cervical Pathology, as published in the Journal of the American Medical Association, new clinical practice guidelines recommend that women with borderline, or abnormal Papanicolaou (Pap) test results should undergo immediate testing for the human papillomarivus (HPV).

The Pap smear is an annual screening procedure during which a physician scrapes cells from the cervix for examination under a microscope. The results of the Pap smear are then classified into five categories: negative or within normal limits (normal); atypical squamous cells of undetermined significance (ASCUS); low-grade squamous intraepithelial lesions (abnormal); high-grade squamous intraepithelial lesions (abnormal); or carcinoma (cancer).

Every year, more than 2 million women in the United States receive an ASCUS diagnosis from their Pap smear results. Historically, there had been no consensus as to the appropriate management strategy for women with ASCUS results. Because an ASCUS result does not provide much information, women with these results were often referred to undergo more invasive screening procedures, such as colposcopy. Effective management strategies for ASCUS results were necessary in order to identify women who may have significant disease while sparing others from excessive and unnecessary follow-up.

The human papillomavirus (HPV) is a sexually transmitted disease that is the primary cause of cervical cancer. HPV is present in virtually all cases of invasive cervical cancer. The Hybrid Capture II HPV test is a new DNA-based test designed to detect the 13 types of HPV that are associated with cervical cancer, a function that the Pap smear does not provide.

The new consensus guidelines, sponsored by the American Society for Colposcopy and Cervical Pathology (ASCCP), were developed by 29 medical organizations and are the first evidence-based, national practice guidelines for the management of women with abnormal Pap results. The guidelines suggest that women with ASCUS Pap results should undergo immediate HPV testing. Women who are positive for HPV can then undergo appropriate follow-up, while women who are negative for HPV can be assured that they do not have the virus and may be spared from excessive follow-up procedures. Patients whose Pap test results come back abnormal may wish to discuss the HPV test with their physician.

Reference: Wright T, Cox J, Massad L, et al. 2001 consensus guidelines for the management of women with cervical cytological abnormalities.

Journal of the American Medical Association. 2002;287:2120-2129.

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