PAP Test OR Colposcopy for Cervical Cancer Screening?

12.5% to 69% of women with human immunodeficiency virus (HIV) have pre-invasive lesions (PIL) of the cervix. Although the Papanicolaou (PAP) test is the recommended screening approach, it has a high rate of false negativity in HIV-infected women and is linked to significant attrition rates. The present study assessed the effectiveness of routine colposcopy compared to the PAP test during the initial visit for screening pre-invasive cervical lesions in HIV-seropositive women.

The study found-

• Out of the 120 women screened, 18.3% of women had abnormal colposcopy, out of which 54.54% were positive for PIL of the cervix on biopsy as well. 
• 5% of women had abnormal PAP tests, and all had abnormal colposcopy and histopathological findings suggestive of PIL as well. 
• Six women with PIL of the cervix would have been missed if only the PAP test was to be used as the screening modality.
• Colposcopy stood superior in detecting PIL of the cervix in HIV-seropositive women. 

This study suggests that colposcopy should be incorporated as a primary screening tool for pre-invasive lesions of the cervix in HIV-seropositive women.

Singh S, Agrawal S, Seth A., et al. PAP Test Versus Colposcopy for Cervical Cancer Screening in HIV-Seropositive Women: A Case-Control Study. J Obstet Gynecol India. 2024. https://doi.org/10.1007/s13224-024-01955-z