Medically Speaking: Article 6

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Articles and Publications: Medically Speaking

Medically Speaking: Archives

New Advances in Cervical Cancer Screening
from the physician members of the Delaware County Medical Society

Cervical cancer screening has undergone several changes in the past decade. The Pap smear is one of the best screening tests that we have in medicine. Since its introduction in the 1950’s, there has been a steady decrease in the number of cervical cancer cases as well as deaths from cervical cancer. In fact, the American Cancer Society estimates that there will be only 10,370 cases of invasive cervical cancer in 2005. In developing countries without screening programs, cervical cancer remains the leading cause of death in women with over a half million women dying from cervical cancer in the world each year.

Patients have concerns over false-negative testing. This is when a Pap smear is called normal however the patient actually may have disease. In some cases, this can lead to missed cases of precancerous lesions of the cervix which can develop into cancer. The Pap smears have been suggested on an annual basis in order to help minimize false-negative testing. Luckily cervical cancer is generally slow to develop and repeated testing identifies most abnormalities.

If a Pap smear does show an abnormality a simple test called a colposcopy can be performed, biopsies can be taken, and precancerous lesions can be diagnosed and treated with simple surgical procedures which just remove the abnormal cells from the cervix. This has led to the continued decrease of true cervical cancers.

In the early 1990’s new Pap smears began to be developed which rather than being placed on a glass slide are actually placed in a solution. This liquid-based technique allows for the removal of inflammation and a better viewing of the cells. This has been shown to increase the detection of cervical cancer precursor lesions to a greater extent. Most healthcare providers now offer liquid-based testing.

In the past several years new testing for human papillomavirus (HPV) has become available. HPV is a widespread virus which is present in almost all cervical cancers and cervical cancer precursors. Currently testing is available to determine if there is any virus present within the cervix. This testing can actually be done out of the liquid-based Pap smear. When women have double negative testing for both the Pap smear and HPV virus, they are at an extremely low risk for having any disease. In some studies this has approached 100%.

Current guidelines for screening from the American Cancer Society include the use of the HPV DNA testing in women greater than 30 years of age. In younger women, the HPV virus may be present as an infection and not be an indication that there are any precancerous changes. The increased detection rate of using both Pap and HPV can safely extend the screening interval to up to three years. Women should still get yearly examinations, however, the better testing allows for longer screening intervals.

In addition, women who have had a hysterectomy may no longer need to have Pap smears performed. Women over the age of 70 who have had three or more normal Pap smears in a row and have had no abnormal Pap smears over the past 10 years may choose to stop having cervical cancer screening. This is because these two groups of women are extremely low risk.

Overall continued developments have improved the detection of cervical cancer. It is important to note that approximately 50% of the cancers that develop are in women who have never been screened or have been screened greater than five years from their diagnosis. It is important to see your healthcare provider to get cervical cancer screening.

Note: this article is presented through the efforts of the Delaware County Medical Society and is intended for informational purposes only, the contents should not be intended as medical advice. “You and Your Doctor – Preserve the Relationship”.

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