DNA/HPV test more accurate than Pap Smear
According to the Center for Disease Control and Prevention’s latest statistics, “11,820 women were diagnosed with cervical cancer in 2003, and 3,919 women died from the disease that same year.” For the past fifty years, physicians have used the pap smear test to find abnormal cells that can lead to cervical cancer. Women all over the United States get pap smears yearly to help reduce their risk of getting cervical cancer through the sexually transmitted human papillomavirus (HPV). HPV is the leading cause for cervical cancer.
Now, a relatively new test promises to be more accurate than the pap smear in the early detection of cancerous and precancerous cells. On October 18th, the New England Journal of Medicine published research regarding the DNA/HPV test, which uses molecular technology to detect HPV.
“It is a very exciting test that will give us more specifics. It is more accurate than traditional pap testing,” Dr. Carolyn Johnson, KU’s Student Health Services Department of Gynecology, said. “The pap smear, which is about 55 percent accurate, depends on cytotechnology, looking at the cells and seeing if they look abnormal. It’s more subjective. The DNA/HPV, which is 94 percent accurate, is more black and white.”
This new test may not be the answer for much of KU’s female student population. Although student health services perform the DNA/HPV test at Watkins Memorial Health Center, Johnson does not recommend it for traditional college-aged students. According to her, the test is not recommended for women under the age of 30 as a primary screening device.
“Young women are often exposed to many types of HPV. The immune system will naturally clear it without us ever knowing,” Johnson said. “If we use a more detailed test and find the HPV, it will just cause worry. Unnecessary further testing will be done and will cost a lot of money.”
Dr. Steven Bruner, Lawrence Family Medicine and Obstetrics, said that HPV is necessary to get cervical cancer, but most people who get HPV never get cervical cancer. Agreeing with Dr. Johnson, he said the DNA/HPV test is not recommended as a primary screening tool for women under the age of 30. It can be used, he said, alongside the traditional pap smear where circumstances warrant.
“There has been a progression of the use of this test since it’s been discovered,” Bruner said. “Some pap smears are in the gray area, the fudge factor that may show abnormal cells. It’s our practice to use the DNA/HPV as a tie breaker for these tests.”
The DNA/HPV test uses colposcopy, magnifying the cervix, to take a closer look at the abnormalities. Burner said doctors then biopsy the abnormal cells. If they are precancerous, the patient receives further treatment. Cytotechnologist and anatomic pathology section supervisor at Lawrence Memorial Hospital, Dr. Scott Mersmann, said HPV/DNA testing is most commonly used in deciding what the next step is after an abnormal pap smear.
“A small group of women are constantly positive with HPV,” Mersmann said. “An even smaller group gets cervical cancer. The HPV test helps decide which women are at greater risk. It helps decide whether the doctor needs to keep an eye on it and what actions to take.”
Mersmann said doctors can use the same cells extracted from the pap smear to perform additional HPV/DNA testing. This allows for quicker results. Not all women are lucky enough to have additional testing done in a short amount of time. A University of Kansas senior who wished to remain anonymous said she has to return to the doctor for further testing.
“It really scared me,” she said. “I got a call from the doctor saying my pap smear results showed dysplasia, my cells were abnormal. They said I had to come back in six months to have another pap smear. I have to wait until then to know how serious it is. Now I’m stuck waiting and worrying.” The student said she wishes a more detailed test could have been done.
Johnson said she would recommend the more sensitive HPV/DNA test for a woman who is more than 30 years old and in a stable sexual relationship. She said women might prefer the test because even though the cells are collected in the same way, if the test came back normal it would not have to be done again for three years. The decrease in the frequency of the test has not been officially recommended and is still tentative. Johnson said she has some concerns regarding the decrease in frequency.
“Women will need to remember that they still need to have breast exams and check ups,” Johnson said. “Just because you don’t need a pap smear every year does not mean you don’t need to see a doctor every year.”
Another concern Johnson has is the expensive price of the DNA/HPV test. She said since research is still being done, insurance companies might not cover the test. Therefore, before the test gets widely utilized the insurance companies will need to get on board.
Although the DNA/HPV test is a more accurate way of testing for the virus, the test is not meant to replace the pap smear as a primary tool for testing. Because of the sensitive nature of the test and subjective age groups, the DNA/HPV test may never be the primary testing tool. Johnson said each woman is different and will require different tests.
“The important thing is for a woman to have a good conversation with her doctor about the best test for her. Women need to decide what is best for them.”