You may have read the study released this week that suggests that testing for HPV (human papilloma virus) may do a better job than the traditional Pap smear in detecting early precancerous cervical cancers. The authors of the study suggest that the HPV test is so sensitive in detecting early cervical cancers, that Pap smears aren't needed.
The results are provocative, but what does it mean for us?
The evolution of the Pap smear, HPV testing and vaccination is one of the great success stories in cancer screening and prevention. Decades ago, cervical cancer was the #1 cause of cancer death for women in the U.S. Since the adoption of annual Pap screening for cervical cancer, the rates of this type of cancer have plummeted. That rate dropped further over the past decade when more sensitive collecting techniques using liquid based technology further improved the accuracy of the test.
Equally impressive is the recent discovery that HPV causes the majority of cervical cancers. HPV is a sexually transmitted virus that is transmitted by vaginal intercourse. It can take years for HPV infection to manifest as precancerous changes on the cervix and then even more years for the precancerous changes to develop into cancer.
That lead to the development of a revolutionary vaccine against HPV released last year called Guardasil.
Currently, most physicians recommend that Pap testing be started within 3 years of vaginal intercourse or at least by age 21 to detect and treat the disease early. Pap tests should be performed annually until age 30, where they can be spaced out every 2-3 years if the Paps have been normal and there is no increased risk of infection. I receive a gynecological exam every year.
Since each new sexual partner increases a woman's risk of getting the virus, women who have multiple sex partners should be tested more often as should women with HIV infection, which is associated with a very high risk of cervical cancer.
I offer Guardasil to all my female patients under the age of 26 (the lowest age limit is 9, but my practice is limited to those over age 16). I perform HPV testing every 2-3 years on women over the age of 30 to look for high risk forms of the virus.
This latest study confirms this thinking. It shows that performing the HPV test alone without the Pap smear found more early or precancerous cervical cancers than the Pap smear.
So are Pap smears passé?
Not yet. The study also found that the HPV test gave false positives - meaning, it detected cancerous growth when in fact there was none to be found.
Thus, experts still disagree whether HPV testing can be performed without doing a Pap smear. For now, I think the message is that women NEED to get screened. And that screening should include Pap smears and HPV testing if indicated.