It appears the days of the Pap smear may be numbered.
A recent study from the NEJM showed that a DNA test outperformed the Pap smear in reducing deaths from cervical cancer.
This has tremendous implications worldwide, where cervical cancer continues to be a significant cause of death. Not only is the DNA test effective, it’s also inexpensive, costing around $5.
Pap smears take a longer time to result, and have to be read by a pathologist. On the other hand, while still needing a cervical sample via a pelvic exam, the DNA test can be read by a machine.
Furthermore, the DNA test can be done once every 3 to 10 years, instead of the current guidelines which call for more frequent Pap smears.
So, will American physicians adopt the new DNA test?
Debbie Saslow of the American Cancer Society says it may be awhile before we see widespread implementation of the test in the United States: “The average gynecologist, especially the older ones, says, ‘Women come in for their Pap smear, and that’s how we get them in here to get other care.’ We’re totally overscreening, but when you’ve been telling everyone for 40 years to get an annual Pap smear, it’s hard to change.”
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{ 3 comments }
Women’s magazines have been encouraging women to ask for the DNA Pap for some time now (although I think initially it was a more expensive test).
I noticed Kaiser has adopted the 3-year interval for women in my age bracket. I wonder if that is really appropriate for women who may be accumulating new HPV exposures in the interim.
Kevin, thanks for pointing to this important study. Unfortunately, you failed to mention that it was specific to resource poor settings that are unable to do pap smears.
There are other studies from Canada and Sweden that point to the effectiveness of the HPV DNA test, but not as a replacement for pap tests entirely. It’s also more helpful for women over 30. Women under 30 often clear HPV infection, and a Pap is a more reliable assessment of cervical health.
For more info, see this editorial in the NEJM from 2007: http://www.ncbi.nlm.nih.gov.libproxy2.umdnj.edu/pubmed/17942878?dopt=Abstract
What if a woman had a cervical conization following colposcopy and biopsy? Does she gain any benefit from this test, considering she likely has HPV, which may or may not resolve? Aren’t ThinPrep Pap tests machine-read and flagged for human follow-up if something appears awry? Enquiring women need to know…
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