In April of this year, the U.S. Food and Drug Administration approved human papilloma virus (HPV) testing as an alternative to traditional pap smear for women 25-30 years of age. Both tests detect cervical cancer, which affects about 12,300 women in the United States per year and kills 270,000 women each year worldwide.
In writing an obituary for the pap smear as we once knew it, I would have to acknowledge the many lives it has saved over the last 70 years. To clarify, I'm referring specifically to the traditional pap smear in which cells are removed from the cervix/vagina and looked at under a microscope.
While the traditional pap smear has certainly served its purpose, research results have necessitated that we move from it to testing for HPV, which was first determined to cause cervical cancer in 1976. Since then, it has become well-recognized that 70 percent of all cervical cancers are related to two strains of HPV.
Pap smear screening has been successful due to the long time — usually 10 years — between HPV infection and the related development of cervical cancer. More recently, testing for HPV began to be employed in abnormal pap smears of undetermined significance to help determine if a cervical cancer precursor may be present.
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A problem with the traditional pap smear was its difficulty of interpretation. In one study, 78 percent of normal pap smears were actually abnormal on review and only 47 percent of high grade (very suspicious) paps were confirmed as actually high grade. HPV testing, in contrast, is accurate and easier to interpret — positive or negative — and is therefore less subjective.
The traditional pap smear still could be used as a part of the clinical approach if the HPV test is positive, but would not have to be a part of the initial evaluation. Guidelines are still undergoing revision and will likely change for the 25 to 30-year-old age group.
There has been hesitancy among health care providers to employ HPV screening. Barriers include increasingly complex management algorithms that change frequently, fears that women will be less inclined to present for routine examinations and lack of education among care providers and patients alike.
You should discuss with your doctor whether HPV screening is an option for you.
I mourn the loss of the traditional pap smear and all it has done for women's health, but I embrace HPV testing as the new kid on the block in the fight to eradicate this horrible, preventable cancer.