Page 74 - Screening for Cervical Cancer: Systematic Evidence Review

Chapter IV. Discussion

Definitive evidence on which to base recommendations and further model performance of HPV

will be available from US and European trials within the year.

Benefits and Harms

The tangible benefit of cervical cancer screening is reduction of cervical cancer morbidity

and mortality by identification of treatable precursors or early stage disease. Intangible benefits

(such as reassurance for those with normal Pap tests) or concurrent preventive care at the time of

Pap testing (such as screening for sexually transmitted disease or contraceptive counseling) are

not documented. These intangible benefits are of particular interest because presumably they

play a role in the persistence of annual screening among low-risk patients. Although some

observers postulate that such overscreening occurs as a result of provider habit and the tradition

of the annual pelvic examination, published evidence does not address either patient or provider

knowledge, attitudes, or desire for annual testing.

Harms of screening are poorly understood. The majority of relevant research documents

the psychological distress associated with the having an abnormal Pap test. Qualitative studies

suggest: (1) women have unmet information needs about the meaning of abnormal results and

lack factual information about what to expect during subsequent evaluation; (2) they experience

distress and anxiety before and after evaluation while the diagnosis is unknown; and (3) patient

education interventions can successfully reduce the fear and uncertainty associated with follow-

up care for abnormal Pap testing. 74-80 Long-term concerns of women with and without definitive

diagnosis of cervical abnormality and the influence of previous evaluation and outcomes on

future screening behavior are unclear.

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