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Can You Trust Your Pap Smear?

What about the new technologies we've been hearing so much about that claim to be better than the Pap smear?

In my view, any new technology or treatment approved by the Food and Drug administration for safety and efficacy may be of benefit to patients in general in that their doctors now have another tool, which may enhance their diagnosis and treatment. In fact, a recent study in the Journal of the American Medical Association showed that these technologies all improved the sensitivity of Pap smears in detecting abnormalities. Other studies have found that these tests-when used with the Pap-reduce screening errors. But what women really need to know about the new tools for diagnosis of cervical abnormalities is:

  • These tests are all currently indicated to be used in addition to-not instead of-the traditional Pap smear. Advertising and promotional campaigns for new products that promote fear and distrust of the Pap smear are inappropriate, confusing, misleading, and ultimately harmful. Ask your doctor what kind of test s/he recommends for you.
  • The exam that you must go through as a patient is unchanged from the traditional internal exam required for a Pap smear.
  • Each of these tests adds additional short term cost (from $5--$60); whether or not these tests will be cost-effective for you depend upon your past history, your diagnosis, your personal comfort level with the information you have, and your financial situation. Whether or not the additional costs for these tests are covered by your insurance plan depends upon your plan, not your doctor. Ask up front if you are covered. If not, find out why. Don't let your insurance company's policy determine what tests you have. If your health care provider recommends testing or if you feel strongly that you want one of these additional tests, tell your doctor you are willing to pay out of pocket for it and then follow-up with your insurance carrier relentlessly until you are reimbursed.
  • You don't need to become an expert in all of these different tests; your doctor does. If you have questions about them, read on; consult other background informational sources about them; and most importantly, ask your health care provider.
  • All of these tests have one critical variable in common- they don't have any benefit if you don't take the test. And, for patients who really object to having an internal exam, there is a new home screening self-test in development that may be on the market within the next two years. This test requires a woman to take a vaginal swab and mail it to a laboratory where it is tested.
  • There are currently several categories of new diagnostic techniques that aim to improve the quality of PAP smear results: those that use computer enhanced technology to better view the smear; those that improve the quality of the smear preparation itself; those that actually can diagnose HPV (the causative agent of most cervical cancer); and those that automate several of the tedious portions of slide processing that make it easier for cytotechnologists (the person who actually reads the Pap smears) to do their jobs. The only downside to these tests is that of additional cost; many insurance carriers are not yet reimbursing for them, although this is changing rapidly. Despite the additional cost per test, insurers are recognizing the potential cost savings as they may reduce the need for repeat tests, repeat doctors' visits, cervical biopsies, and needless anxiety. For most women, these new tests are nice to have, but are probably not necessary. Unfortunately, many women who could potentially benefit most from these technologies have their access to them most limited by financial obstacles. Remember, the most important thing for most women is to have your Pap smear done annually (or more frequently if recommended by your physician). In this way, we can make the goal of eliminating cervical cancer deaths in the 21st century a reality.

    Specific New Tests:

    AutoPap ®, PapNet®: These are computerized screening/rescreening devices that can be run non-stop and which are reported to be more accurate at picking up cellular abnormalities than technologists. Currently they are used mostly as "back-up" ("rescreening") to traditional screening, as a computerized second opinion to catch "false-negatives", those tests which were reported as "normal" but which actually contained abnormal cells. The idea of computers rather than trained cytotechnologists reviewing Pap smears is a novel one-and for some, an uncomfortable one-in the US. But in other countries such as Japan, this practice is now standard. The added cost--rather than its added accuracy-seems to be the focus of most objections thus far. As with most newly introduced medical technologies, this should become less of an issue over time.

    Thin Prep ®: This test addresses the challenges of proper sample collection. It is a thin layer liquid-based preparation that allows the entire sample to be collected and then viewed more completely in its entirety. Its use decreases the need for repeat exams due to inadequate sampling. The process is more sensitive and specific than a traditional Pap smear; it reduces false negative test results considerably. The FDA has called ThinPrep "significantly more effective" than the standard Pap.

    HPV Testing: A study just last month in JAMA suggests that home HPV testing may detect more cervical disease than an in-office Pap smear. While this test is not yet available to consumers, the hope is that once it is, it will greatly increase access to cervical screening and play a major role in preventing cervical cancer. There is currently an FDA-approved HPV DNA test available to physicians as an adjunct to the Pap smear. This test can accurately identify whether a woman with HPV is affected by one of the 13 key cancer causing HPV types.

    Created: 2/24/2000  -  Donnica Moore, M.D.

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     In 1997, a Gallup survey commissioned by the College of American Pathologists found that although nearly 9 out of 10 women surveyed knew they should have a Pap test every year, nearly 4 out of 10 of these women failed to do so in the previous year. Why? 

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