Cervical cancer screening

TO THE EDITOR: In their excellent review of cervical cancer screening,1 Jin and colleagues discussed the current screening guidelines advocated by various medical organizations. The authors wisely advised clinicians to modify these guidelines when the lifestyle of an individual patient differs from the expected behavior of the patient’s peer group. For example, they said “it is probably reasonable to continue screening in women age 70 and older who are sexually active with multiple partners and who have a history of abnormal Pap test results.” To this I would add that it seems reasonable to continue screening a woman over 70 who is sexually active with multiple partners, even if she still has no history of abnormal Pap test results. Similar reasoning might be applied to the statement, “women age 30 and older who had negative results on both Pap and HPV testing should be screened no more often than every 3 years.” This makes sense on a population-wide basis, since women over 30 are more likely to be married and have fewer sexual partners. But why should women who continue to have multiple sex partners into their 30s be screened any less frequently than women in their 20s? The high negative predictive value of HPV-plus-Pap testing is based on the risk characteristics of the population being screened, as well as on the technical characteristics of the tests. Rigid adherence to screening guidelines may be a disservice to individuals whose lifestyles place them at higher risk than the norm for their age cohort.