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October 2014

Human Papillomavirus Testing for Primary Cervical Cancer Screening: Is It Time to Abandon Papanicolaou Testing?

Author Affiliations
  • 1Division of Gynecologic Oncology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. 2014;174(10):1539-1540. doi:10.1001/jamainternmed.2014.4021

In the 1920s, when George Papanicolaou began to develop the screening test that now bears his name, the cause of cervical cancer was not known, and the cancer was a common cause of death among women. Since Papanicolaou testing entered clinical practice in the 1950s, however, cervical cancer incidence and mortality have markedly decreased in the United States. In 2014, there will be an estimated 12 360 new cases of cervical cancer and 4020 deaths attributable to the disease.1

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    1 Comment for this article
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    The Pap smear tests directly for the entity being screened
    David L. Keller, MD | Independent
    I agree with Dr. Feldman's assessment that it is not yet time to abandon the Pap smear in screening for cervical cancer. After all, the Pap smear, when positive for malignancy or pre-malignant cytology, is a test which directly detects the entity we are screening for. High risk strains of HPV may be the causative factor in all or nearly all cases of cervical cancer, but screening for HPV is one degree removed from the critical entity. Women do not die from HPV infections. Repeat, women do not die form HPV infections. Women die from cervical cancer. There is a comfort, and a certainty, to retaining a test which looks for malignancy directly, rather than detecting an infection which can cause malignancy.
    CONFLICT OF INTEREST: None Reported
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