Cervical cancer screening has been one of the great success stories in cancer prevention, and we owe much of this to the Pap test. The Pap test screens for precancerous cellular changes in the cervix and is one of the most effective ways to detect cervical cancer early. Since its introduction in the 1950s, the rate of cervical cancer deaths has been plummeting year after year. Cervical cancer was once the most common cause of cancer death among women, but today it is entirely preventable with proper screening.
In the 1990s, medical research discovered that the human papillomavirus (HPV) plays a role in causing cervical cancer. With this knowledge, HPV vaccination and HPV testing, which identifies the presence and type of HPV infection, were introduced as additional ways to help protect against cervical cancer.
Today, the Pap and HPV tests are most often performed simultaneously in women over 30. One swab yields one sample — but two tests are run by the lab in the Pap-plus-HPV test.
But last year's FDA approval of a stand alone HPV test has led to serious debate about whether doctors should continue using the Pap test to screen for cervical cancer or just use the HPV test alone.
At a recent meeting in Baltimore, hosted by the American Society for Colposcopy and Cervical Pathology (ASCCP), I joined women's health experts from around the country to discuss the latest topics related to cervical cancer, including medical professional guidelines, vaccination and the current debate on the best approach to cervical cancer screening.
Simply put, I believe using HPV testing alone puts women's lives at risk because it misses more cervical cancers. Findings from three recent studies published in Cancer Cytopathology, a peer-reviewed journal of the American Cancer Society, highlight new evidence that reaffirms this statement.
The largest real-world study of cervical cancer screening strategies found that one in five women in the U.S. with cervical cancer will be missed by HPV alone — that's an estimated 2,400 women with cervical cancer who could be missed annually. Two additional Chinese studies published last month, also in Cancer Cytopathology, further support these findings. One study showed that prior Pap testing identified more cervical cancers than prior testing with HPV alone. The second study found that prior testing with Pap-plus-HPV together found more cancers than prior testing with either test done separately. Together these data affirm that Pap-plus-HPV testing is still the preferred screening standard in cervical cancer and pre-cancer detection.
In addition, these findings support the current professional guidelines, which recommend that women start getting the Pap test at age 21 and then every three years. Pap-plus-HPV is recommended to screen women ages 30-65, every three to five years, regardless of whether they have received an HPV vaccination.
As members of the medical community continue to debate the role of the Pap test in cervical cancer screening, now, more than ever, it's important for women to know and understand the types of tests they are receiving when deciding how to protect themselves from cervical cancer. It's important to remember the Pap test has proven to be one of the most successful cancer screening tools in history. We've made considerable progress over the decades when it comes to cervical cancer screening. These data provide convincing evidence that screening for cervical cancer with an HPV alone test would tragically miss many cervical cancers that would be detected by Pap-plus-HPV — and mark a large step backward.
Dr. Michael Randell is an Atlanta-based obstetrician gynecologist. His email is drrandell@obgynatl.com.