Why You Still Need a Pap Test?

Why You Still Need a Pap Test: Confusion about this essential procedure is growing among women of all ages. Despite the new HPV vaccine, regular screenings are still critical

For decades, the message to women was clear: get an annual gynecological exam and a Pap test to screen for cervical cancer. Since the development of the Pap test in 1941 by Dr. George Papanicolaou, deaths from cervical cancer have dropped more than 70 percent, making it the most effective cancer-screening tool yet created. The message reached so many women that regular gynecological checkups became the standard in this country, saving millions of lives. But recently, vaccines targeting viruses that cause cervical cancer and new recommendations for less-frequent screening for certain subsets of women have muddled that critical message. In one recent study of 351 patients at a New Jersey family health center, more than half of all women surveyed indicated that they really didn't understand what a Pap test is for. There's also disturbing new evidence that poor women continue to have significantly higher rates of cervical cancer than other women, primarily because they're not getting regular screenings and not following up when Pap test results indicate possible malignancies.
Doctors are frustrated by what appears to be a growing gap between scientific advances in detecting cervical cancer and women's knowledge of how to protect themselves. A new generation of liquid-based Pap tests gets much more accurate results than the traditional test, says Dr. R. Marshall Austin, professor of pathology and director of cytopathology at Magee-Womens Hospital, University of Pittsburgh Medical Center. The new tests, developed in the mid-1990s, collect many more cells, significantly increasing the chances of spotting abnormal ones, Austin says. In the United States, more than 50 million women receive an annual Pap test and about 80 percent are collected using a liquid-based test called the ThinPrep Pap Test, Austin says.
More accurate results have prompted medical organizations to recommend that some women who go several years without abnormal results get screened less often. This can be a problem, according to some experts. "Unfortunately, a lot of these efforts to increase the interval of screening are confusing," Austin says. The best advice: stick to a regimen of annual gynecological exams and follow your doctor's individual recommendations for how often you need to be screened. Annual exams, with or without a Pap test, are especially important after menopause, when a woman's risk of cancer increases. A number of studies have shown that many women don't know the symptoms of gynecological cancers. That's why the end of fertility does not mean the end of checkups.
Women are also confused by news of vaccines against genital human papilloma virus (HPV), which has been linked to about 70 percent of cervical cancer cases. "Women need the Pap test regardless of the HPV vaccine," says Dr. Mona Saraiya, medical officer in the Centers for Disease Control's Division of Cancer Prevention and Control. Since genital HPV is primarily transmitted during sexual activity, the vaccine is most effective for girls who have not had intercourse. In fact, the American Cancer Society recommends that the vaccine be routinely given to 11- and 12-year-old girls. (It's not recommended for women over 26, but research is underway on the effectiveness of giving the vaccine to women 27 and older.) Several states have pending legislation mandating vaccination for young girls, which has prompted fierce debate. However this is resolved, older unvaccinated women will still be vulnerable and need Pap tests. And even those young girls who are vaccinated will need to be screened as they get older since the current vaccine does not protect against all forms of HPV. A Pap test is still the only way to detect cervical cancer.
Saraiya was the lead researcher on a study published in the current issue of the journal Obstetrics and Gynecology that found that African-American and Hispanic women, as well as women in the South, have higher rates of cervical cancer--largely because of lower screening rates and less follow-up after an abnormal Pap test finding. Saraiya says the results confirm earlier studies showing that poorer women generally have limited access to health care. Will the vaccine be just one more health tool unavailable to low-income women?
"That's a big question in all our minds," Saraiya says. "The HPV vaccine has huge potential to wipe out these disparities but if there are barriers to getting the vaccine, including the cost, then we might continue to see these disparities. "
Cervical cancer is nearly 100 percent curable if caught at an early stage, so education about prevention and screening is the best protection for women of all income groups. According to one recent report, as many as 70 percent of women who developed cervical cancer either did not have a Pap test within five years of their diagnosis or had never been screened. And if you haven't had a gynecological checkup in the last 12 months, call your family doctor now.
[AP]