The goal of cervical cancer screening is to prevent morbidity and mortality, while a key purpose of the new guidelines is to decrease harm. We don’t want to find young women who have transient HPV infections and transient abnormal Pap tests. Most changes will go away in young women, and that is why we are not going to screen women under age 21. The SEER data tells us there is almost no cancer, but there is so much HPV infection, and many abnormal Pap tests.
So, the optimal screening strategy is to:
We used to think that with LEEP (i.e., loop electrosurgical excision procedure), we had a way to easily treat the cervix and remove HPV disease. But LEEP is not benign, treatment is not benign, and can lead to problems in pregnancy in women. We know from the natural history data that there is absolutely no need to over treat and over respond with young women with transient HPV infections and lesions that will go away.
[94] Saslow D, Solomon D, et al “American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening Guidelines for the Prevention and Early Detection of Cervical Cancer, Journal of Lower Genital Tract Disease, 2012;6;(3):175-204.
