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Research Letter, Viewpoint, Invited Commentary Examine Cervical Cancer Screening Intervals

JAMA Internal Medicine Study Highlights

A by Zahava Berkowitz, M.S.P.H., M.Sc., of the , and colleagues found that most of the 2,087 primary care clinicians surveyed recommended (pap) tests sooner than recommended by guidelines after co-testing for the human papillomavirus (HPV). (Online First)

Clinical guidelines recommend that women 30 years and older with a negative test result for oncogenic HPV with a concurrent normal Pap test result not be tested again for at least three years, according to background in the research letter.

“From 2006 to 2009, primary care providers consistently reported that they would recommend Papanicolaou testing sooner than recommended by guidelines, especially after normal co-testing results,” the research letter concludes.

Viewpoint: No Pap Tests in Women Younger Than 21 Years or After Hysterectomy for Benign Disease

In a Viewpoint, Nancy Morioka-Douglas, M.D., M.P.H., and Paula J. Adams Hillard, M.D., of the Stanford University School of Medicine, California, write: “Performing Papanicolaou tests in women younger than 21 years and in those with total hysterectomy for benign conditions poses clear risks without documented benefit, and evidence-based clinical guidelines recommend against Papanicolaou testing in these women.”

“The annual cost of Papanicolaou tests in these women is approximately $850 million. For specific high-risk populations, including women with a history of cervical cancer or high-grade cervical lesions, those who were exposed to diethylstilbestrol in utero, and those who are immunocompromised or human immunodeficiency virus infected, screening may be appropriate,” the Viewpoint concludes.

Invited Commentary: Doing Less in Health Care is Hard

In an invited commentary, study by Michael L. LeFevre, M.D., M.S.P.H., of the University of Missouri, Columbia, writes: “Morioka-Douglas and Hillard present the rationale for two of the Choosing Wisely recommendations for doing less: do not perform Papanicolaou tests on patients younger than 21 years and do not perform Papanicolaou tests on women who have had a hysterectomy for benign disease.”

“Leaving costs out of the debate, the case that the use of Papanicolaou tests in women in these clinical situations results in more harm than good is compelling,” he concludes.


JAMA Internal Med. Published online April 8, 2013. doi:10.1001/jamainternmed.2013.368.

JAMA Internal Med. Published online April 8, 2013. doi:10.1001/jamainternmed.2013.316.

JAMA Internal Med. Published online April 8, 2013. doi:10.1001/jamainternmed.2013.535.