Exciting news in women’s health: a relatively cheap DNA test for HPV (the virus that causes cervical cancer) looks like it works better than Pap smears in preventing cervical cancer through early detection. (New York Times, New England Journal of Medicine).
This is huge for developing countries. The widespread use of Pap smears in the US and other developed countries has made cervical cancer largely a preventable disease. But in much of the world, repeated office visits for cytology that must be read by a pathologist are just not doable. In this study, a single HPV test made a significant impact.
The article has started an interesting debate about the role this will play in the US - it sounds likely that HPV testing will continue to prove better than Pap smears. That alone won’t change women’s experiences much (the DNA sample is still obtained from the cervix, so it requires a pelvic exam), but we may be able to stretch out the interval between screenings.
As both the NY Times article and the editorial accompanying the NEJM article point out, research has already shown that the interval between Pap smears can be extended after enough negative tests, and that screening very young women for cervical cancer leads primarily to excessive procedures. Neither of those has been fully accepted yet by either gynecologists or patients. Presumably any proposals to use relatively-infrequent HPV testing as the primary screening modality will be met with similar caution, so I expect we’ll be doing annual exams for the foreseeable future.
It’s interesting to think about how this will affect my practice, though - it is weird to imagine a clinic schedule where annual exams don’t predominate!
(I have to say, also, that the New York Times article gets a gold star for health reporting. Not only does it accurately report the results of the study, but the background information it provides is all correct. I’m particularly impressed that the article points out that the current recommendations for Pap smears are not for every year in most women, and that most women do contract HPV but the vast majority of these infections are benign and cleared up quickly by the body’s defenses.)