Could Pap Smears Soon Be A Thing Of The Past?

by Lisa Sadikman
Originally Published: 

Folks with vaginas, get ready to relax that pelvic floor. In the very near future, ice-cold speculums and cringe-inducing cervical scrapes could be but a distant memory.

That’s right. Pap smears may soon be a thing of the past.

That’s because a new study published in the Journal of the American Medical Association (JAMA) found that cervical human papilloma virus (HPV) testing may be better able to detect cancer cells than the traditional Pap smear for women 30 and older. HPV testing involves a less invasive gathering of vaginal fluid while a Pap smear, or cytology testing, usually involves an uncomfortable cervical scrape to capture cells.

Now, which one would you rather deal with?

The study, funded by the Canadian Institute of Health Researcher, tested 19,000 women ages 25 to 65. Participants were randomly separated into two groups: one received HPV testing only and the other received cytology testing. Those in the HPV group who tested negative returned after four years for HPV plus cytology testing (known as co-testing). Those in the cytology group who tested negative returned after two years for another round of cytology testing, then again in two more years for co-testing.

The results showed fewer cases of precancerous cells in the HPV testing group than the Pap smear group over the four years. That’s because the HPV test is more accurate at detecting potentially cancerous cells, which makes sense because 99.7 percent of all cervical cancers are related to HPV. Women in the HPV group who tested positive for the virus after the first round of testing were able to deal with any wonky cells early on. For this reason, after the four years, the study showed that screening with primary HPV screening resulted in significantly lower incidence of precancerous cells than cytology screening alone.

“What our study shows is that by using HPV testing, we detect precancerous lesions earlier,” lead study author Gina Ogilvie, MD, PhD, said in an interview with NPR. “If women have a negative HPV test, they are significantly less likely to have a precancerous lesion four years later, meaning we can extend screening time.”

The report also noted that adding HPV testing to the Pap test group resulted in finding 25 lesions that would have not been found by the Pap test alone. By adding the Pap test to the HPV group, an additional three lesions were found. Clearly, the difference in accuracy is significant. However, it’s difficult for the medical community to recommend HPV testing only if it means missing the signs of cancer in some women, no matter how small the number.

“In the US, co-testing is currently the recommended gold standard, and neither doctors nor their patients should be willing to give up the added benefit you get from screening with a Pap test and HPV test together,” said Dr. Mark Spitzer, medical director of The Center for Colposcopy in Long Island, New York, and past president of the American Society for Colposcopy and Cervical Pathology told CNN. Dr. Spitzer was not involved in the study.

According to the World Health Organization, cervical cancer is the fourth most frequent cancer in women worldwide. The American Cancer Society estimates that 13,240 cases will be diagnosed this year and 4,170 women will die from the disease. It’s one of the most common causes of cancer death in the United States.

For now, the U.S. Preventive Services Task Force recommends women over 30 have a Pap smear every three years or both a Pap and HPV test every five years. However, the organization issued a draft recommendation last fall endorsing either a Pap smear or an HPV test rather than co-testing. Final guidelines have yet to be issued, although this new study seems to bolster the recommendation.

Even if the guidelines do change, keep in mind the Pap smear is the test of choice for women 21 to 29. That’s because HPV is extremely common in this age group (unless you’ve had the HPV vaccine). HPV testing alone would most likely come up positive much of the time, however, most HPV at this stage clears up on its own and doesn’t morph into abnormal, precancerous cells. Using just the HPV test would most likely lead to unnecessary intervention, like colposcopy and biopsy.

So what’s the bottom line?

For now, there’s no official move to HPV testing only, so talk to your doctor about the options. While ditching the speculum and scrape sounds like a dream, staying cancer-free is the most important goal.

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