A comparison of simultaneous cervical cytology, HPV testing, and colposcopy.

This pilot study explores the screening techniques for premalignant and malignant disease of the cervix. Given current knowledge of the etiology and progression of cancer of the cervix, should family physicians screen patients with Papanicolaou (Pap) smears, Human Papillomavirus (HPV) smears, colposcopy, or some combination of these three? In a retrospective audit of 75 patients comparing simultaneous Pap smears and colposcopy, 5 of 8 patients with biopsy-proven cervical intraepithelial neoplasia (CIN) and one with invasive cancer had normal Pap smears. Because of this high false-negative Pap smear rate, a prospective study comparing a simultaneous Pap smear, HPV smear, and colposcopic examination (with biopsy when indicated) was undertaken. Seventy consecutive patients seen by the author for routine pelvic examinations consented to and were enrolled in the study. Seven patients had biopsy-proven CIN lesions; 2 were found by Pap smear, 3 by colposcopy, and 5 by HPV smear. The Pap smear missed 5 lesions, colposcopy missed 4, and the HPV smear missed 2. Further studies are needed to determine the optimal screening method for CIN.