What About the Pap Smear?

In 2008, the New York Times noted that pharmaceutical companies made a forceful push to get Gardasil to the public, even though critics were wary that the long-term outcome was unknown. It only took Gardasil six months to be approved after submitting their application to the FDA. The Center for Disease Control recommended the product shortly after, even though it can take years for most vaccines to be accepted.

Adverse effects from the HPV vaccine are already being reported, but other impacts may be less obvious, such as a false notion that the vaccine prevents cervical cancer.

Forgotten Pap Smear

Amid mounting skepticism over the safety and effectiveness of the HPV vaccine, our attention seems to have been drawn away from the cervical cancer prevention method of yore – The Papanicolaou smear, or, as you may refer to it as, the Pap smear.

A British cervical cancer specialist, Angela Ruffle, stated in the New York Times that she was against any fast adoption of Gardasil in England. She was not just wary of adverse side effects from the vaccine, but also concerned about a false sense of confidence that could deter women from getting regular Pap smears, which are still necessary to detect strains of HPV that Gardasil does not vaccinate against. Mrs. Ruffle cautioned that “if we do this quickly and badly, we can cause more deaths.”

Even the lead developer of Gardasil, Diane Harper, underlined the importance of the Pap smear:

“The best way to prevent cervical cancer is with routine Pap screening starting at age 21 years. Vaccination cannot prevent as many cervical cancers as can Pap screening… Gardasil is associated with GBS [Guillian-Barre Syndrome] that has resulted in deaths. Pap screening using a speculum and taking cells from the cervix is not a procedure that results in death.”

What the Cell?

When my legs are in stirrups for my pap smear, I’m usually concentrating more heavily on pushing my tailbone down, as opposed to what the procedure actually entails. As it turns out, your nurse practitioner, or doctor, is actually scraping at your cervix to collect a sample of cells.

Yes, they’re scraping at your cervix, but it sure beats Guillian-Barre Syndrome.

The doctor then places the cell sample into a container that will be sent off to the laboratory for inspection. Any abnormalities detected in the cell samples allow doctors to take preventative measures against cervical cancer.

Promoting Fewer Pap Smears

Pap smear views have shifted, though, and in June, the US Preventive Services Task Force (USPSTF) made changes to their 2003 recommendations, calling for less frequent pap tests. Women should now begin Pap testing at the age of 21, with no more than one Pap smear every three years; whereas women were previously urged to begin Pap screening within a few years of becoming sexually active, and obtain a Pap test at least every three years, though more frequent screening was recommended.

The USPSTF changed its Pap Smear recommendations for the same reason it recommended fewer mammograms: The false positive results led to invasive, painful, and costly biopsies that were unnecessary. False positives findings from Pap smears could also result in future pregnancy risks.

HPV is common, but most healthy men and women are capable of eliminating the infection on their own, so detection of HPV does not necessarily lead to cervical cancer. For this reason, the USPSTF recommends against regular HPV screening for women younger than 30 years of age. And if you are 30, you can put off your Pap screening for 5 years if you combine the Pap test with HPV testing.

HPV Testing – The End for Pap Smears?

There is now a Hybrid Capture II High-Risk HPV DNA test that analyzes DNA from your cervix to detect high-risk HPV. A study supported by the Bill and Melinda Gates Foundation found that HPV DNA testing significantly reduced advanced cervical cancer, as well as deaths from cervical cancer.

The low-cost HPV DNA test will have a major impact in developing countries, where cervical cancer results in over 250,000 deaths a year, but the Pap Smear has already reduced the number of deaths caused by cervical cancer to 4,000 per year.

The Pap smear, however, may very well be run out of town now that HPV DNA testing is included in the Affordable Care Act, offering women over 30 HPV testing every three years. Of course, it’s hard to say, since this HPV DNA test only detects 13 types of HPV; and while the types of HPV tested for are high-risk, cancer-causing strains, there are at least 100 different strains of HPV, which means at least 87 strains will not be detected.

Regardless of whether or not Pap screening will be replaced with the HPV DNA testing, it’s important to note that regular screening is necessary to detect and prevent cervical cancer; the HPV vaccine alone does not prevent cervical cancer.

This article was published originally on Hormones Matter in July 2012.