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Should U.S. Women Be Screened for Cervical Cancer With Pap Tests, HPV Tests, or Both?Should Pap Tests, HPV Tests, or Both Be Used to Screen for Cervical Cancer?

Rebecca B. Perkins, MD, MSc; and Elizabeth A. Stier, MD
[+] Article, Author, and Disclosure Information

This article was published online first at www.annals.org on 10 June 2014.

From Boston University School of Medicine, Boston, Massachusetts.

Acknowledgment: The authors thank Dr. L. Stewart Massad for his review of the manuscript and insight into the benefits and limitations of cervical cancer screening options.

Grant Support: By American Cancer Society Mentored Research Scholar Grant (MRSG-09-151-01).

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1043.

Requests for Single Reprints: Rebecca B. Perkins, MD, MSc, Boston University School of Medicine, 85 East Concord Street, 6th Floor, Boston, MA 02118; e-mail, rbperkin@bu.edu.

Current Author Addresses: Drs. Perkins and Stier: Boston University School of Medicine, 85 East Concord Street, 6th Floor, Boston, MA 02118.

Author Contributions: Conception and design: R.B. Perkins, E.A. Stier.

Analysis and interpretation of the data: R.B. Perkins, E.A. Stier.

Drafting of the article: R.B. Perkins, E.A. Stier.

Critical revision of the article for important intellectual content: R.B. Perkins, E.A. Stier.

Final approval of the article: R.B. Perkins, E.A. Stier.

Collection and assembly of data: R.B. Perkins, E.A. Stier.

Ann Intern Med. 2014;161(4):295-297. doi:10.7326/M14-1043
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In April 2014, the U.S. Food and Drug Administration approved the Cobas HPV [human papillomavirus] test to be used alone to screen for cervical cancer in women aged 25 years or older. This commentary discusses the advantages and disadvantages of the newly approved test. The authors emphasize that increasing screening rates should be the major focus of efforts to reduce invasive cervical cancer regardless of which test is used.

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Comparison of screening algorithms with Pap testing, Pap and HPV cotesting, and primary HPV testing.

High-grade lesions include HSIL, atypical glandular cells, atypical squamous cells that favor HSIL, and carcinomas. ASCUS = atypical squamous cells of undetermined significance; HPV = human papillomavirus; HSIL = high-grade squamous intraepithelial lesion; LSIL = low-grade squamous intraepithelial lesion; Pap = Papanicolaou.

* For Pap−/HPV+ results, testing for HPV types 16 or 18 with immediate colposcopy for positive results is an option.

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