No More Pap Smears?

If you’re a woman over 21, that headline probably got your attention. After all, who likes Pap smears? Wouldn’t it be great to never need one again?

Well, don’t get too excited, because the alternative is not more fun and could result in more invasive tests. Here’s what you need to know.

Some physicians are suggesting that Pap smears be replaced with an equally invasive but less conclusive test, the HPV test, when women reach the age of 25 or 30. If the HPV test indicates the presence of HPV (or human papillomavirus, which is very common in sexually active young women and usually goes away by itself), women will be urged to undergo an even more invasive procedure called a colposcopy. Patients describe a colposcopy as being like a Pap smear that takes 20 minutes instead of a few seconds.

The purpose of a Pap smear is to test for abnormal cells in your cervix that could eventually turn into cervical cancer. Two strains of HPV virus are responsible for 70 percent of cervical cancers. It’s very common for sexually active women to be infected with HPV, but usually the body gets rid of the virus within a year or two all on its own. HPV can only cause cancer when it lingers in the body for several years and starts to damage the cervix.

Even if a woman has had an HPV vaccine, she could still potentially develop cervical cancer, so experts advise women to get a Pap smear every three years, starting at age 21 and ending at age 65.  Starting at age 30, women are given the option of asking their doctor to use the same sample for a Pap smear and the test for HPV. If nothing suspicious is found, they can get screened using both tests every five years instead of every three for the Pap smear alone.

Current guidelines recommend that if a woman has an abnormal Pap smear and an HPV test indicating that she has the types of HPV that can cause cervical cancer, she should undergo a colposcopy to see if she needs surgery. The other, less expensive alternative is for women get Pap smears to screen for problems, and only get an HPV test if their Pap results indicate abnormal cells.

The company that makes HPV tests would like to sell more of them, and that will also increase the number of colposcopies, which are even more expensive. So it’s been urging physicians, the FDA, and the U.S. Preventive Services Task Force (USPSTF) to change the guidelines so that the HPV test will be used to screen healthy women. Instead of an optional use with Pap smears, it wants the HPV test to be used on its own to screen all healthy women starting at age 25 or 30.

Unfortunately, the HPV test by itself isn’t very useful because so many young women have HPV that will disappear without any treatment. Having an HPV test without also getting a Pap smear to check for problems has the potential to scare a lot of women who are not developing cervical cancer.  Instead of waiting a few months to see if the HPV goes away by itself (which it typically does), the company wants those women to get a colposcopy, which is as painful as a Pap smear but the pain lasts longer and the procedure costs more. And like a Pap smear, the test isn’t always accurate.

Otherwise, it’s a great idea.

In 2014, the FDA approved HPV tests as a replacement for Pap smears for women 25 and older, although they did not recommend it. We’re not the only ones who disagreed. The experts at the U.S. Preventive Services Task Force have recommended that the HPV test only be used on women 30 and over, and only in combination with a Pap smear. They pointed out that if the HPV test is used on younger women, the results can’t distinguish between HPV that would go away on its own and HPV that could cause cancer. This would lead to unnecessary worry for young women and many unnecessary colposcopies.

We have pointed out to the FDA and the USPSTF that Pap smears provide inexpensive and effective screening. In fact, the women who get cervical cancer are usually women who did not regularly get Pap smears or follow-up.

Research indicates that the way to save lives is to help women get screened with Pap smears, not to put them through unnecessary follow-up procedures. The American College of Gynecologists—the doctors who do Pap smears, HPV tests, and colposcopies—also support the current policy of Pap smears alone or co-testing with HPV tests for women over 30, rather than replacing Pap smears with HPV tests alone. In addition, the experts participating in the Choosing Wisely Campaign recommended against HPV tests for women under 30.

We believe that the more expensive and painful procedures would discourage women from getting screened or following up after receiving suspicious results.

Why did the FDA approve HPV tests to be used without a Pap smear? And why is the USPSTF now considering that option for women over 30? It seems that FDA policies regarding diagnostic tests and other medical devices are too often ignoring scientific evidence, and instead and who make recommendations based on facts, rather than embracing every new “innovation” in health care, regardless of whether it will work. We hope that the USPSTF does not follow that lead.

When the “old ways” are effective, let’s not throw them out unless there is proof that the new, more expensive way is better.

An earlier version of this post appeared in Huffington Post and Maria’s Country Kitche