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Cervical Cancer Rates After the Transition From Annual Pap to 3-Year HPV and Pap

Dinkelspiel, Helen MD1; Fetterman, Barbara SCT (ASCP)2; Poitras, Nancy PMP2; Kinney, Walter MD3; Cox, J. Thomas MD4; Lorey, Thomas MD2; Castle, Philip E. PhD, MPH5

Journal of Lower Genital Tract Disease: January 2014 - Volume 18 - Issue 1 - p 57–60
doi: 10.1097/LGT.0b013e31829325c3
Original Articles

Objective Kaiser Permanente Northern California (KPNC) introduced 3-year Pap and human papillomavirus DNA cotesting for cervical cancer screening in women 30 years or older in 2003 to 2004. Patient and provider willingness to extend screening intervals and the impact on annual cervical cancer incidence after interval extension are evaluated.

Materials and Methods Age-adjusted cervical cancer rates and screening intervals were calculated from KPNC Regional Laboratory databases and Northern California Cancer Registry from 2000 to 2009.

Results The median screening interval between negative cotests was 36 months compared to the 16 months after a negative Pap test alone before the implementation of cotesting. The age-adjusted invasive cancer rate was 6.5 per 100,000 women in 2000 and 6.3 in 2009; there was no difference in the rates of cervical cancer in women 30 years or older from 2000 to 2009 (p trend = .7).

Conclusions Patients and providers were compliant with the extension of screening intervals with cotesting. Cervical cancer rates remained constant during the 10-year study period despite extending screening intervals after a negative cotest.

Extending screening intervals to 36 months after a negative cotest in women 30 years or older did not increase the incidence of invasive cervical cancer.

1Division of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, New York, NY; 2Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA; 3Department of Women’s Health and Division of Gynecologic Oncology, The Permanente Medical Group, Oakland, CA; 4University of California Santa Barbara (Retired), Santa Barbara, CA; and 5Albert Einstein College of Medicine, Bronx, NY

Reprint requests to: Helen Dinkelspiel, MD, Division of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave, HIP 8-838, New York, NY 10032. E-mail:

The authors did not receive funding for this study.

Dr Cox serves on the scientific advisory boards of Gen-Probe and Roche and on the Speakers Bureau for Roche. He is a consultant for OncoHealth and serves on the Data and Safety Monitoring Board for Merck. Dr Castle receives compensation for serving on a Data and Safety Monitoring Board for Merck. Dr Castle has received HPV tests and testing for research at a reduced or no cost from Qiagen and Roche.

The other authors have declared they have no conflicts of interest.

Dr Castle is a Visiting Professor at Albert Einstein College of Medicine.

Presented at the Society of Gynecologic Oncologists, Plenary Session VII, Orlando, FL, March 4–9, 2011.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology