Pap or HPV Test — or Both?

The medical community is divided about whether a Pap smear or an HPV test is best to detect cervical cancer. The debate was stoked earlier this month when a committee of gynecologic oncology experts categorically voted for only the HPV test.

As reported by NPR, representatives of the American Society for Colposcopy and Cervical Pathology and the Society of Gynecologic Oncology reviewed the usefulness of the HPV test for cervical cancer detection, and whether it should be given in addition to, or instead of, the Pap test.

Per the report, published in Gynecologic Oncology, the committee concluded that doctors could consider the HPV test a primary screening test for women 25 years and older.

The human papilloma virus (HPV) is thought to cause most cases of cervical cancer, and last year the FDA approved a test for the virus as a primary screening test for the malignancy. For several years now, an HPV vaccination for adolescents has been recommended before they become sexually active to protect girls from developing cervical cancer later in life and boys from developing genital warts, penile and/or anal cancer.

HPV is the most common sexually transmitted infection.

For decades, women routinely have been given Pap smears to catch any signs of cervical cancer early. It involves scraping cervical cells to be sent to a lab to see if any are abnormal. If so, they can be removed before cancer develops. Lower rates of cervical cancer have been attributed to this routine testing, detection and treatment.

But, according to NPR, “Pap smears are probably missing a fair amount of cancer and precancer in women,” said Dr. Warner Huh, the chairman of the committee that issued the report. “The HPV test really outperforms Pap smears when it comes to cancer detection as well as precancerous detection,” and that it would enable doctors to “pick up disease in women that could be treated earlier so they don’t go on to develop cervical cancers.”

Not so fast, said members of the American Congress of Obstetricians and Gynecologists (ACOG), an organization that tends to uphold traditional care and treatment, as we’ve blogged. ACOG believes that it’s too soon to supplant the Pap smear with the HPV test.

So does Diana Zuckerman, head of the National Center for Health Research. “So many women get HPV who will never, ever get cancer,” she told NPR. Her advocacy group, like ACOG, is concerned that an initially positive HPV result will frighten women unnecessarily and prompt overtreatment.

It’s a fair point, because many screening tests, as we’ve observed, can yield the presence of something concerning but that, in fact, will never develop into something that requires treatment. The detection of something benign not only causes fear, but often additional tests that can be expensive, uncomfortable and cause complications of their own.

As the NPR story noted, many HPV infections are temporary, and resolve on their own without causing any problems. So Zuckerman wants both professionals and consumers to understand that better detection doesn’t necessarily mean better medicine.

She also pointed out that cervical cancer isn’t caused solely by the HPV. So if you substitute the HPV test for a Pap test, you might miss other potential cases of cervical cancer. It’s not a matter of reliance on the HPV test being controversial, only premature. Her solution, at least for now, is to use both tests.

That’s the more-is-more approach to medical care, one that we’ve often called into question. The best approach for women, as always, is individual – the tests you decide to have, and their frequency, depend on your medical history, your family history and your habits.

Making a decision about having either the HPV or the Pap test, or both, should be the result of a frank and full discussion with your doctor. Ideally, that person is informed of all medical points of view, and remains objective for each patient’s concern.

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