Pap test no longer gold standard
Experts with a federal advisory panel are recommending that an HPV test be approved as a first step to screen for cervical cancer.
The test is used sometimes in conjunction with the Pap smear.
But just how eager doctors will be to discard Pap smears, long considered the gold standard for cervical cancer detection and prevention, is unclear.
A Food and Drug Administration advisory panel voted unanimously last week that a new HPV test could be used before or instead of a Pap smear to screen for cervical cancer. The FDA, which adopts the recommendations of such panels, has yet to rule on the issue.
“This is looking at the cells a step earlier,” said Dr. Thomas Krivak, a gynecological oncologist at Allegheny Health Network, who previously did HPV research with colleagues from Walter Reed Medical Center in Bethesda, Md.
In 2010, the most recent year numbers are available from the Centers for Disease Control and Prevention, 11,818 women in the United States were diagnosed with cervical cancer; 3,939 women died from it.
The Pap smear analyzes cells scraped from a woman's cervix for precancerous abnormalities that could become cancerous if left untreated.
The HPV test checks for evidence of the human papillomavirus that can trigger such changes in cells. It focuses on two strains of the virus, the HPV16 and HPV18, that are linked to tumors.
Under the recommended standard, women who test positive for one of the two strains under the HPV test would be referred for additional testing and/or treatment.
HPV causes genital warts in men and women and certain head and neck cancers.
Dr. David Chelmow of the Virginia Commonwealth University School of Medicine told the FDA panel that the American College of Obstetricians and Gynecologists supports HPV testing as primary screening for cervical cancer. Krivak calls the test “very interesting.”
“HPV testing has been around for about 15 years now, and we're refining how to use it in our clinical practice,” he said.
“I think HPV testing is here to stay, and it is going to replace Pap smears with some practitioners. I personally think HPV testing, as well as HPV vaccine, are two of the most important developments during my career as a women's health provider.”
The Pap smear has been used since the late 1940s. The American Cancer Society credits it with a major role in reducing deaths from cervical cancer by almost 70 percent between 1955 and 1992.
The test, recommended for women between 21 and 65, remains an annual event for many women despite recent recommendations that Pap smears can be limited to once every three years, or if used in conjunction with an HPV test, once every five years for women ages 30 to 65.
“The HPV test is a little more expensive than the Pap smear, but when you lengthen it out so you can do less frequent screening, it's cost-effective,” Krivak said.
“But you need to remember a Pap smear or an HPV test is not a pelvic exam. It doesn't mean you don't go to your primary care doctor and that they don't do a pelvic exam to make sure there are no abnormalities. This is not a substitute for that.”
Debra Erdley is a staff writer for Trib Total Media. She can be reached at 412-320-7996 or firstname.lastname@example.org.
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