The Pap Test Changes Cervical Cancer Survival
Most women regard a Pap Test as a routine part of their reproductive health care. Sometimes you don’t even notice the moment during your exam when your doctor swabs or brushes the cervix to collect cells from its surface. This small sample of cells is sent to a lab where it is examined to look for pre-cancerous or cancerous cells within the sample.
In 1943, Dr. George Nicholas Papanicolaou published his description of a simple procedure that could distinguish normal from abnormal cells taken from swabs of the vagina and cervix. Within the next few years, large numbers of women had the Pap Test as part of their annual gynecologic exam, and cervical cancer rates began to fall dramatically.
Why was the Pap test so effective? First, cervical cancer develops on a body surface doctors can examine. It isn’t hidden inside the body where only surgical exploration can reveal it. Second, cervical cancer has a relatively long pre-cancerous stage. The Pap test enabled doctors to find and remove the pre-cancer before it could develop into a cancer. A single Pap test does not find every cancer or pre-cancer; false negatives are not uncommon. But because women were screened every year, the test was very effective in finding cervical cancer early.
HPV Testing–A New Option For Early Detection
We know much more about cervical cancer than your grandmother’s or great-grandmother’s doctor did when he first recommended the new Pap test. By the late 1970s to early 1980s, gynecologists generally agreed that some types of Human Papilloma Virus (HPV) can cause cervical cancer. This awareness brought us a prevention tool (the HPV vaccine) and also a new test to identify women at risk for cervical pre-cancer (the HPV test). The HPV test does not look for abnormal cervical cells. Instead, it looks for the HPV virus by testing for the presence of its DNA (genetic material). The HPV test can be offered alone or combined with a Pap test (using the same sample).
Discuss Your Individual Screening Plan With Your ObGyn
Professional organizations and individual doctors have not reached complete agreement about which cervical cancer screening method has the most advantages. Recommendations also vary about the age to start testing, how often to test, and the age at which women should feel comfortable to stop testing.
We generally agree that it is not necessary to test women younger than 21, whether or not they are sexually active. HPV can be transmitted without sexual intercourse; however, an HPV infection in a very young woman is likely to resolve without treatment. Cervical cancer in this age group is very rare.
Women over age 65—who have had the recommended screenings for the last 10 years with no abnormal result—have a low risk for cervical cancer. Discuss with your doctor whether or not you want to continue screening.
When choosing the type of cervical cancer screening, the general recommendation for women of average risk is one of the following:
- A Pap test alone every 3 years; (this is the only recommendation for women age 21 to 30).
- Co-testing—which is a Pap test combined with an HPV test every 5 years.
- An HPV test alone every 5 years.
Each plan has a small percent of false positives (abnormal results that turn out not to be cancer or pre-cancer) and false negatives (a true cancer or pre-cancer that is missed by the test). The differences are small. Abnormal results require additional testing and/or treatment. Colposcopy—a procedure that allows your doctor to examine the cervix closely with a microscope-type instrument, is the next step after an abnormal test. If the colposcopy shows a possible abnormal area, your doctor will take a tiny biopsy for further examination by a pathologist.
The screening method and schedule your doctor at Sparks & Favor recommends will depend on your individual situation. Have you had previous abnormal Pap or HPV tests? Are you a smoker? Are you immunocompromised? Do you have a regular record of annual well-woman exams? Risk tolerance is a personal choice. Are you comfortable with the small risk that the standard recommendations impose on you, in order to avoid a colposcopy that finds nothing abnormal? Be sure to keep your doctor informed about your personal risk factors and family history.
We know that the schedule above catches most early abnormalities in women of average risk. But life gets in the way, insurance changes, and sometimes your intention to make regular preventive care a priority gets off the track. When you next see your gynecologist, you may realize it’s been far too long since your last Pap or HPV test. A Pap test is very quick and easy when you are already having an exam.
No cancer screening plan will find every cancer or pre-cancer. There will always be risk. We try to find a balance between protecting our individual patients from the consequences of a serious cancer and subjecting people with no disease to the discomfort, anxiety, and cost of testing. The government develops recommendations for acceptable statistical risk in a population of millions of women. You and your doctor should consider whether you are comfortable with that level of risk.
The Importance of Regular Women’s Preventive Care
All of this discussion really misses the most important point! Our goal for you is to prevent cervical cancer from ever developing. Nearly 15,000 American women each year hear that they have cervical cancer. 5000 women still die of the disease. Loss of fertility after a hysterectomy for cervical cancer is another serious consequence. Most cervical cancer cases in the United States develop among women who did not did not have adequate screening. Getting the HPV vaccine before you are 26 is very effective prevention, but we still recommend regular screening regardless of vaccination status. Finding and treating pre-cancers before they become cancers saves lives and fertility.
With best wishes for good health in the New Year!
Sarah Whitehead MD