Many readers know that I am a big fan of Jane Brody. Her weekly column often has a wonderful summary of a complex issue. This week is no exception – Pap Test: Champion Against Cervical Cancer

Cervical cancer has been perhaps the biggest success story in the long-running war against cancer.

Once the leading cause of cancer deaths in women, cervical cancer will this year account for 4,100 deaths, not even 1 percent of cancer deaths among American women. Credit for the progress goes almost entirely to the Pap smear, a test now administered to 50 million Americans a year.

Despite the excellent results we have achieved with routine Pap smears, we now can probably achieve even better results. The improvements take advantage of our growing knowledge of the cause of cervical cancer.

For many years before the discovery that viruses could play a major role in causing human cancers, it was obvious that cervical cancer was a sexually transmitted disease, little different in its pattern of transmission from syphilis and gonorrhea. The earlier a woman became sexually active and the more sexual partners she or her partner had, the more likely she was to develop this cancer.

This pattern clearly implied that something transmitted in sexual intercourse increased a woman’s risk of developing cervical cancer. That something, it is now known, is a very common virus called human papillomavirus, or HPV, the same virus that causes warts, including genital warts.

Scientists have also learned that HPV exists in more than 100 forms, but only 13 are considered likely to cause cancer. It is now possible to screen women for the presence of an infection with one of the high-risk strains.

This screening adds important information to the routine Pap smear. In fact, most practices now have adopted the new guidelines for cervical cancer screening.

Rather than having every woman tested every year, the new schedule has been changed to take into account age, medical and sexual history, presence of HPV infection, results of past Pap tests and even the type of Pap test used.

The new guidelines should greatly reduce the number of women who are told that their test is abnormal and thus requires further evaluation. (Most of these abnormalities cure themselves.)

Under the previous guidelines, 2.5 million to 5 million women a year were called in for more testing to find about 5,000 cancers, according to Dr. Carmel Cohen, the director of gynecologic oncology at the Mount Sinai Medical Center in Manhattan, who headed the committee that produced the revised guidelines for the American Cancer Society.

About half the 13,000 cases of cervical cancer that occur each year are found in women who have never been screened, Dr. Cohen said.

…

Rather than having every woman start screening at 18, the groups now recommend starting three years after the onset of sexual activity or by 21, whichever comes first. After that, screening should be done every year with the regular Pap test or every two years using the liquid Pap until age 30.

If a woman 30 or older has had three normal test results in a row, the interval can increase to every two to three years.

But there are important exceptions. Annual screening may still be recommended for women with certain conditions that increase their cancer risk like smoking; infection with a cancer-causing form of HPV; infection with the AIDS virus; chlamydia infection; poor diet; exposure to DES, a synthetic estrogenlike drug, in utero; treatment with immune-suppressing medication or a weakened immune system; and a personal or family history of cervical cancer.

Women 30 and older can have a Pap test and an HPV test at the same time. The double test is not advised for younger women because they are much more likely to be infected with HPV and also to eliminate the virus in a few months or a year. In older women, the virus infection is much less common but is more likely to be persistent.

This year, the Food and Drug Administration approved using the HPV test in conjunction with the Pap test for women over 30. Previously, it was used only when the Pap test showed abnormalities. If a woman over 30 has a normal Pap test and no viral infection, she may safely wait three years to repeat her exams, according to the new guidelines.

Woman 70 and older who have had three or more normal Pap tests in a row and no abnormal test in the last 10 years can stop cervical cancer screening. Also, screening is not needed for women who have had total hysterectomies, unless cervical cancer was the reason for the surgery.

These guidelines do represent a significant change which responds to our newer better data. Some physicians might want to make copies of this article to hand out to patients!