Karen Smith-McCune, M.D., Ph.D., of the University of California, San Francisco, writes: "The updated guidelines leave physicians and other clinicians with a question: is cotesting with Pap-plus-HPV testing truly preferred over Pap testing alone (the American Cancer Society/the American Society of Colposcopy and Cervical Pathology/the American Society of Clinical Pathology recommendation), or are the options equivalent (the U.S. Preventive Services Task Force recommendation)?"
"Once a straightforward process, screening for cervical cancer is now increasingly complex. Absent better data about the advantages and disadvantages of Pap testing and cotesting in various settings, clinicians should help their patients make individual decisions about cervical cancer screening that incorporate their values and preferences. The designation of cotesting as the preferred approach in one set of screening guidelines may be premature," Smith-McCune concludes.
Can the New Cervical Cancer Screening, Management Guidelines Be Simplified?
Sarah Feldman, M.D., M.P.H., of Harvard Medical School, Boston, writes: "Women in the United States are cared for in private offices, public health clinics, and other diverse settings, with different tests and resources for cervical cancer screening. Thus, obtaining more evidence about a variety of cost-effective approaches to screening and surveillance should be a priority."
"Furthermore, as HPV testing becomes an option separate from cotesting, new screening and surveillance strategies should be studied in as many diverse settings as possible. Although the [American Society for Colposcopy and Cervical Pathology] guidelines for the management of abnormal cervical cancer screening tests are well intentioned, they should and can be simplified. Guidelines that are easy to implement in clinical practice help clinicians avoid mistakes and optimize patient care," Feldman concludes.
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