How to Proceed after Abnormal Pap Results

New guidelines designed to help clinicians decide how to manage women whose Pap tests are abnormal were published in the April 24, 2002, issue of the Journal of the American Medical Association (JAMA).

The new guidelines describe how best to utilize new technologies, including liquid-based cytology and DNA testing for human papillomavirus (HPV), the primary cause of cervical cancer. One of the most important recommendations addresses women with the most common type of abnormal Pap test, called ASCUS, or atypical squamous cells of undetermined significance. Prior to these guidelines, women with ASCUS would have either several repeat Pap tests or undergo a colposcopy. The new guidelines say other approaches may still be used, but HPV testing is preferred whenever liquid-based Pap tests are employed. If the liquid test is used, the laboratory can test the same sample used for the original Pap test for HPV, eliminating the need for a repeat doctor visit.

The test can reassure women who are HPV negative that they are unlikely to have cervical cancer, while identifying those women who are HPV positive and in need for further evaluation. For women with more serious abnormalities on their Pap test, the guidelines recommend colposcopy and find HPV testing has no role. This is an important change in recommended practice. The American Society for Colposcopy and Cervical Pathology (ASCCP) sponsored the guidelines, working with representatives from 29 national organizations and federal agencies involved in women's health care.

JAMA is making the Consensus Guidelines available at no charge on the Internet (www.ama-assn.org).




Related Links:
Consensus Guidelines