You Mean I Don’t Need a Pap Every Year!

I am flabbergasted and stunned. After reading the article in the New York Times, “DNA Test Outperforms Pap Smear,” I am speechless. And, I’m not just referring to the new development that a new DNA test for the virus that causes cervical cancer will eventually replace the Pap smear. I’m referring to the fact that the article reveals a fact of which I was not aware. “Since 1987, she (Debbie Saslow, director of gynecologic cancer for the American Cancer Society) said, the cancer society and the American College of Obstetricians and Gynecologists have recommended Pap smears only every three years after initial negative ones. In 2002, they recommended the HPV test too, and evidence is mounting that the Pap smear can be dropped.” Dr. Saslow went on to say that, “‘But we haven’t been able to get doctors to go along… 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.’”

The article then reveals that this new development, DNA testing for cervical cancer, may only have to be done every 3 years. “Not only could the new test for human papillomavirus, or HPV, save lives; scientists say that women over 30 could drop annual Pap smears and instead have the DNA test just once every 3, 5 or even 10 years, depending on which expert is asked.” However, the significance of this test will depend on the gynecologists’ willingness to administer this test instead of the Pap smear. In the 1950s, when cervical cancer was a leading cause of death for women, the Pap smear was extremely effective. However, today, cervical cancer only accounts for less than 4,000 deaths each year. So, the importance or significance of the Pap smear has lost its validity. The article notes that most countries may have been reluctant to administer the DNA test because of its overwhelming cost. But, “In poor and middle-income countries, where the cancer kills more than 250,000 women a year, cost is a factor, but the test’s maker, Qiagen, with financing from the Gates Foundation, has developed a $5 version and the price could go lower with enough orders, the company said.” In this country, Pap smear results may take several days. But the DNA screen will be read by machines, providing results much quicker. In third-world countries, Pap smears fail because women often can not return and there are fewer available trained gynecologists. A study conducted in India revealed, “…none of the women who were negative on their DNA test died of cervical cancer.” With this test, women over 30 may not need testing but every 5 to 10 years, improving quality of life and reducing deaths due to cervical cancer.

So, if this is true, why would the doctors in the United States not provide this type of information to their patients? I’ve been having unnecessary panic over getting a Pap smear annually, when I could have been getting them every 3 years. Why would the doctors not inform us of this fact? Is it to make more money, and not necessarily to improve our quality of life? I have several sisters, and after speaking with them, they revealed that they were never told this by their gynecologists. Why? Other research revealed that:
* If you are younger than 30 years old, you should get a Pap test every year. If you are age 30 or older and have had 3 normal Pap tests for 3 years in a row, talk to your doctor about spacing out Pap tests to every 2 or 3 years. If you are ages 65 to 70 and have had at least 3 normal Pap tests and no abnormal Pap tests in the last 10 years, ask your doctor if you can stop having Pap tests. (http://www.womenshealth.gov/faq/pap-test.cfm#pap04).
* You should have your first Pap smear when you start having sex or by age 18. Continue having a Pap smear once a year until you've had at least 3 normal ones. After this, you should have a Pap smear at least every 3 years, unless your doctor thinks you need them more often. Keep having Pap smears throughout your life, even after you've gone through menopause. (http://familydoctor.org/online/famdocen/home/women/reproductive/gynecologic/138.html).
* If you are over age 30 or your Pap smears have been negative for 3 years in a row, your doctor may tell you that you only need a Pap smear every 2-3 years. (http://www.nlm.nih.gov/medlineplus/ency/article/002125.htm).

So, I have to continue to wonder about the motivation behind gynecologists’ insistance on annual Pap smears, especially for women over 30 years old. Is it monetary based or quality of life concern? According to the article, the hesitation is not because of high costs of the DNA test. “Dr. Jan Agosti, the Gates Foundation officer overseeing its third world screening, said Qiagen’s new $5 test — which proved itself in a two-year study in China — runs on batteries without water or refrigeration, and takes less than three hours. In countries where women are ‘shyer about pelvic exams,’ she added, it even works ‘acceptably well’ on vaginal swabs they can take themselves.”

You can be sure that I’ll be bringing up this matter with my gynecologist, especially since the dreadful time has come this month. Now, I can’t wait to go to the doctor.