Cervical Cancer Screening: Pap Smear Pros & Cons
There’s a new recommendation under consideration for cervical cancer screening. If it’s accepted, it will give many of my women readers unprecedented freedom to choose when and how to be tested. I’m all for choice, but not this time. It’s complicated, but I’ll explain.
The American Cancer Society estimates that cervical cancer screening saves more than 4,000 lives a year. It’s a remarkably successful prevention mechanism, in widespread use since the early 1950s. In 1975, for example, an estimated 5.6 women per 100,000 died of cervical cancer. In 2011, that rate was 2.3 per 100,000—the mortality was nearly cut in half.
There are two screening tests: the Pap smear, named for its pioneering inventor, and the human papillomavirus (HPV) test. Both take samples of cervical cells to look for precancerous or cancerous abnormalities. Finding them early means a crucial head start to prevention efforts.
Screening practices already differ by a woman’s age, the procedures her doctor recommends, and their frequency.
The currently accepted norm for healthy women, aged 30–65, calls for a Pap smear every 3 years and a Pap smear plus an HPV test every 5 years—a practice called co-testing. (The practice is different with a history of abnormal pap smears or an HPV diagnosis.)
Some doctors recommend co-testing every year.
At the opposite end of the spectrum, some medical professionals believe the Pap smear should be abandoned altogether, in favor of HPV testing only, for women 30–65.
This last school of thought—testing for HPV only, and for women aged 30–65 only—is where the recommended changes, if adopted, will have their most visible impact.
But is there risk entailed for the possible future HPV-only cohort? Is it really OK to tell the venerable Pap smear to step down—for the first time in decades?
What’s the best approach? Let’s have a look.
About the Pap smear
The Pap smear, is done on a sample of cells collected from the cervix, to look for cell growth that may indicate abnormal cancerous or precancerous conditions.
The Pap smear, however, is by no means bulletproof. It tells some women with precancerous, abnormal cells that they’re fine, and others with no abnormal cells that yes, cancerous or precancerous cells are present.
These false positives and false negatives are a serious matter, delaying treatment for some women who are at risk of cervical cancer, but don’t know it, and driving others into treatments they don’t need.
But, while it might be every woman’s dream to avoid the admittedly uncomfortable Pap smear—I’m convinced that the Pap smear is still useful in the screening arsenal. This is not the time to abandon the smear.
About the HPV test
This test looks for types of the HPV virus that can cause cancer, especially for types HPV 16 and 18, which are responsible for 70 percent of all cervical cancers.
But a positive HPV test by no means guarantees a future cervical cancer. HPV is extremely common: about 79 million people have it at any given time, and nearly all sexually active people contract it at least once—at the rate of 14 million new cases per year.
That’s why the HPV test is not recommended by the mainstream community for screening healthy women younger than 21. The virus is so widespread that testing would likely unleash a storm of over-testing, over-diagnosis, and unnecessary interventions. Add to that the anxiety that would surely trouble every young woman with a positive result—needlessly.
Even testing older women can lead to wrong conclusions. The fact is that most infections clear on their own, and millions of younger women who get HPV-positive results will “never, ever get cancer,” according to one expert.
That said, those HPV 16 and 18 strains are definite markers for a higher risk for cervical cancer. It’s essential that they be found and treated.
If the Pap smear isn’t sufficiently reliable, it makes very sound sense to co-test with the HPV test.
“Most of the value of co-testing is from the HPV test because it’s specific—when it’s negative, it’s really negative—and it’s very sensitive, so […] we’re not going to miss people who have pre-cancer or cancer,” says Kevin Ault, an assistant professor of OB-GYN at the University of Kansas Medical Center.
That’s good. That’s the solution to the Pap’s false negative/false positive issue.
And that fits fine with my position.
About my recommended screening regimen
I’m miles away from my Ban-the-Pap colleagues on this issue.
They say less Pap, or no Pap?
I say more Pap:
from onset of sexual activity
|Co-test Pap + HPV annually to age 65|
|Women with abnormal Pap||Co-test Pap + HPV every 6 months to age 65|
Why is my practice so Pap-heavy compared to the mainstreamers recommending HPV testing only?
Because the causes of cancer, both inside us and all around us, are an almost overwhelming force, aided and abetted by their inherent unpredictability. What we know today as a slow-growing cancer can become fast and furious almost overnight.
I would feel undeserving of my practice—indeed, my license to practice—if I were to fail to treat my patients with what others may call too much caution, too much care, or too much haste.
It’s that simple.
So why toss away the Pap smear, a proven tool, even with its imperfections, when another proven tool, HPV testing can help make up for those imperfections?
Now, if we were talking x-rays, CAT scans, MRIs, PET scans and any other radiation-emitting diagnostic tool, I’d be singing a different song, urging all concerned to use them sparingly, only when needed.
But Pap smears and HPV tests pose no frequency threats—and you’ve just read about how Pap smears, all by themselves, have saved millions of lives.
My usual health recommendations, of course, apply to keeping the cervix, and all of the rest of you in tiptop shape. It’s as simple as:
- Healthy diet: organic, fresh, local
- Healthy lifestyle: exercise, good sleep, active social life, de-stressors
There are a million different ways to achieve these simply stated broad, overarching goals. They turn up in nearly every one of my posts.
For cervix-specific health tips, you’ll be doing yourself a world of immediate and long-term good if you avoid:
- Commercial douches
- Scented, synthetic fiber tampons
- Unloving, unwanted, or traumatic sex
What might come next?
If the new recommendation is adopted, women 30–65 will have a choice: HPV testing only, or co-testing with a Pap smear.
How should they decide?
By remembering what I’ve just told you when meeting with their doctor to discuss:
- The last time she was screened
- What type of screening she had
- Which one to have next
- When to have it
I’ll keep readers posted.
Meanwhile, take good care.
- Cafasso, Jacquelyn. “Inflammation of the Cervix (Cervicitis)” Healthline. Reviewed February 12, 2016.
- Haelle, Tara. “For Many Women, Cervical Cancer Screening May Get A Lot Simpler.” NPR. Published September 12, 2017. Last accessed October 2, 2017.
- Stein, Rob. “Specialists Split Over HPV Test’s Role In Cancer Screening.’’ NPR. Published January 8, 2015. Last accessed October 2, 2017.
- ‘’What Are the Key Statistics About Cervical Cancer?’’ American Cancer Society. Revised January 5, 2017. Last accessed October 2, 2017.
- ‘’‘’Human Papillomavirus (HPV)’’ CDC. Updated July 17, 2017. Last accessed October 2, 2017.
- ‘’Draft Recommendation Statement: Cervical Cancer Screening.’’ US Preventive Services Task Force. Published September, 2017. Last accessed October 2, 2017.
- Stöppler, Melissa Conrad. “Cervical Cancer (Cancer of the Cervix)” Published NA. Last accessed October 2, 2017.