Guidelines debut for ambiguous Pap. (First Evidence-Based Data).

NEW YORK -- For the first time, clinicians now have evidence-based guidelines to assist them in the management of the 3.5 million American women who have ambiguous Pap smear findings each year.

Detection of human papillomavirus (HPV) plays a key role in the new consensus guidelines sponsored by the American Society for Colposcopy and Cervical Pathology.

"Although the Pap test has done a remarkable job of reducing cervical cancer in the United States, it is far from a perfect test, leaving many women uncertain and anxious," Dr. Thomas Wright, the lead author of the guidelines, said at a press briefing sponsored by the American Cancer Society.

The previous guidelines--developed before the availability of sensitive molecular detection methods and liquid-based cytology--recommended that women whose Pap smears are classified as "atypical squamous cells of undetermined significance" (ASCUS) undergo repeat testing at intervals of 4-6 months until two consecutive tests are normal, or be referred for immediate colposcopy.

In contrast, the new guidelines recommend DNA testing for HPV on all such ambiguous samples that were evaluated using liquid-based cytology (JAMA 287[16]:2120-29, 2002).

This simply requires that a portion of the cervical cytology specimen be retained in case HPV testing should be needed following the initial screening.

The evidence behind the new guidelines emerged from a recently completed National Cancer Institute--sponsored clinical trial that compared HPV testing with repeat cytology testing or colposcopy.