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Could New Technology Make Pap Smears Obsolete?



It’s hard to believe that less than 100 years ago, cervical cancer was the No. 1 cause of death for women. All of that changed thanks to Dr. George Papanicolaou, who devoted his life to researching ways to detect reproductive cancer in women. “Dr. Pap’s” first research subject was his wife, Mary.

He developed the Pap smear after extensive study of her cervical cancer cells. His test enabled doctors to screen cervical cells for pre-cancerous and cancerous growth. By the 1940s, the Pap smear was adopted by gynecologists all over the United States.

The Pap test has saved tens of thousands of lives and continues to be an essential screening tool. Now, some scientists have suggested replacing the Pap test with a new test called the Cobas HPV test. The new test screens for human papillomavirus (HPV), the virus that’s responsible for 90 percent of cervical cancer cases, instead of looking for cancerous indications already existing among cervical cells. Although the new test has some limitations, it provides women with another important tool for monitoring their cervical health.

What Is HPV and How Do People Get It?

HPV is usually transmitted by vaginal or anal intercourse, although it can also be transmitted during oral sex. In fact, most sexually active people have HPV at some time during their lives. In some men and women, HPV causes genital warts to appear. In others, HPV causes multiple types of cancer including cervical cancer and cancers of the penis, vagina, vulva, and anus. HPV has also been connected to some types of throat cancer.

Because of the prevalence of HPV, gynecologists in San Antonio and all over the world have recommended regular Pap smears for women as part of their annual well-woman checkups. A few years ago, scientists developed an HPV vaccine called Gardasil that, when given to young men and women, has a high success rate of preventing many HPV infections. Even though fewer women die of cervical cancer in developed countries, it’s still the second most common cause of death for women around the world. For this reason, women should get regular Pap smears according to their doctors’ instructions.

The Cobas HPV Test

The Cobas HPV test can detect DNA from 14 types of HPV, including HPV-16 and HPV-18, which most commonly cause cervical cancer. Right now, the FDA recommends the following procedures for using the test:

  • Test cervical cells. Gynecologists use the test to examine a patient’s cervical cells for HPV. Although the testing procedure differs from the Pap smear, gynecologists will still have to take cell samples for study.
  • Colposcopy. Women testing positive for HPV-16 and HPV-18 should have a follow-up colposcopy, which allows doctors to examine the cervical cells more closely. The FDA recommends immediate colposcopy because HPV-16 and HPV-18 cause 70 percent of cervical cancer cases.
  • Pap tests. If a woman tests positive for one of the other 12 types of HPV, she should have a follow-up Pap test to determine whether she needs a colposcopy.

Concerns About Younger Patients

The FDA pointed out that when researchers tested the effectiveness of Cobas HPV, they conducted their study on women over 25 years old. However, although young women aged 25 to 29 test positive for HPV almost twice as often as older women, only 16 percent of women studied were from this high-risk age bracket.

Also, although women from this age group are more likely to carry HPV, they’re least likely to have cancer. Some doctors have expressed concern that these women are at high risk for false positives that could lead to unnecessary procedures. For example, cervical biopsies can weaken the cervical tissue, which might lead to early labor or miscarriage during pregnancy.

For now, both the Cobas HPV test and Pap tests can be conducted on the same cervical swab. In fact, pairing the two tests could prevent women from undergoing unnecessary follow-up procedures. For example, a positive Cobas HPV test with a negative Pap test would indicate that no follow-up was necessary while a negative Cobas HPV test with a positive Pap test would require further exploration.

Unfortunately, the speculum isn’t going away anytime soon. Women should ask their doctors about how a combination of the Cobas HPV test and Pap tests can protect them from cervical cancer.