I also strongly agree with Dr Harper’s assessment that we inform our patients that we are testing for a sexually transmitted disease with HPV DNA testing. I would go a step further and suggest we have this discussion with our patients before doing cervical cytology screening in the first place. Cervical cancer and its precursors are sexually transmitted diseases, and our patients should know that as we are performing their Paps.
I agree with Dr Harper’s conclusions regarding the cost-effectiveness of cervical cytology. As with most forms of population-based screening, the screening interval is a primary determinant of cost. Reasonable evidence from modeling studies has suggested that little benefit is gained with annual vs every-3-year Pap smears.
Finally, I would like to emphasize that the majority of cases of cervical cancer in this country are the result of a lack of screening altogether. Cervical cancer mortality has been reduced by at least 70% since the introduction of the Pap smear. Cervical pathology detection and treatment is one of the largest success stories of primary prevention.
Kenneth J. Grimm, MD,
Family Practice Residency, Oakwood Hospital and
Medical Center, Dearborn, Mich,
and Department of Family Medicine,
University of Michigan, Ann Arbor.