HPV screening more likely to require possibly harmful invasive follow-up tests, doctors say
Article Source: msnbc.com
from:msnbc.comSorry, ladies. Pap still best test for cervical cancer
Seeded on Tue Oct 18, 2011 9:54 AM EDT (msnbc.com)
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Leave a Comment:
Preventive care is integral to maintaining a healthy body. Many cancers are slow growing, silent killers that must be tested before it has gotten out of control, untreatable. Why so many insurance policies do not pay for preventive care is very confusing to me. It is cheaper to prevent than it is to medically treat most illnesses/disease.
Yes, preventive care is important. What about vaccinating boys. If boys could not get the virus, then how could they spread it later in life with sexual contact? What are implications of same sex contact and this virus?? Has it been proven there are no other ways to get cervical cancer that are not related to HPV? If so, then why test for HPV INSTEAD of doing long trusted pap smears?? Just some questions to think about.
Boys can get the virus but there is no test to show if they have the virus (with women they used to test for the virus with cervical exams). Furthermore, up until recently it was believed that males were only carries of HPV, that HPV didn't actually affect them but recent this has been proven untrue. The FDA has recommended for Gardasil for boys now but it's a controversial vaccine, SO controversial that parents are hesitant of letting their daughters (the original recipients for the vaccine) get it; and with presidential candidates adding to parents' fears with completely FALSE claims of it causing mental retardation the likelihood that a parent will get their child (girl or boy) is continually decreasing.
Give it a few years, and more boys and girls will be receiving the vaccine. I work in a pediatrician's office, and have seen quite a few boys starting to get the HPV vaccine, the biggest thing that gets in the way of it is the fact that most insurance companies are not covering it yet, but they will. And once it is a required vaccine for both girls and boys, more parents will get it for their children, except for those, of course, that refuse all vaccines, but that's another issue entirely.
If doctors want more women to be diagnosed, the best course would be to actively look for a test that would replace the pap smear. I have my pap done yearly, but I know many women who never get tested simply because a pap smear is too invasive and would feel like a violation. Plus, if a woman has had a bad technician do their pap smear in the past, I would imagine they would be less likely to have the test repeated.
Spot on, Sarah.
The last time I had a pap, the doctor didn't get an adequate sample and so he automatically sent me to an OB for a colposcopy - where they take a biopsy of my cervix. I've never figured out why, but the whole procedure, not just the couple of seconds the biopsy itself took, REALLY HURT, as in I was begging them to stop (and I'm fairly pain tolerant - I almost always get pinched during a pap and I put up with it). Plus, it turns out nothing was wrong! While cancer is definitely on my list of things I don't want, another test like that is, too.
Medical researchers really need to come up with a less invasive way to do these tests.
They have, it's called the Delphi Screener - women can test themselves at age 30 and if negative you simply test another 4 times at 35, 40, 50 and finally at 60 - only those positive will be offered a 5 yearly pap test, no more than 7 in total. No HPV means you're not at risk from cervix cancer and you just test for HPV infrequently or if no longer sexually active or monogamous you can forget all testing and revisit the subject if your risk profile changes. Only HPV positive women should be offered pap tests.
http://www.delphi-bioscience.com/Company/Paginas/History.aspx
http://www.sciencedaily.com/releases/2011/10/111020163909.htm
Those negative for HPV and monogamous or no longer sexually active can forget all testing and revisit the subject if their risk profile changes.
I think you need a new doctor and I'd be lodging a formal complaint - putting a woman through an unnecessary biopsy is a serious matter. If the sample was inadequate, a re-test should have been organized. If women want to stay with pap testing, please do your reading - testing before 25 is a BAD idea - it won't help, but carries very risk risk. Women between 25 to 30 - no country has shown a benefit, but countries like the UK offer testing from 25, not sure why, it doesn't help - and women should be very careful testing more often than 3 or 5 yearly. Annual testing and testing before 25 WILL land you in day procedure sooner or later - the risks are sky high - false positives galore! But all women should lobby for HPV primary triage testing and the Delphi Screener - it's far more reliable.
"Sorry, ladies"? What's the big deal about a Pap smear? I'm just grateful I don't have a prostate!
Some women are HIGHLY uncomfortable with having them especially younger women (who though 20 have yet to have any sexual contact) and survivors of sexual assault.
Don't forget those of us who've had very painful experiences with pelvics. It's a big deterrent to ever going back to the doctor.
Women who have never been sexually active should not be offered pap tests. I'd question the ethics and competence of any doctor offering a virgin a pap test. America is the only country in the world to include women not yet sexually active in pap testing. I consider it abuse - as it carries high risk for NO benefit - false positives in those under 25 are VERY common - 1 in 3.
In "Time to Change the Policy" by Dr James Dickinson (2002) MJA (online) you'll see the author mentions this fact and then says something like, "surely something that must be ignored in practice" - in other words, it makes no sense to test virgins.
The other fact: pap testing does not change the tiny death rate in sexually active women under 30, but these women produce the most false positives. Many countries do not test before age 30...
Finland has the lowest rates of cc in the world and offer 7 pap tests, 5 yearly from 30 to 60 and send the fewest women for colposcopy/biopsies. The States and Australia, both seriously over-screen and include young women and they both have very high referral rates - this is shameful - a cancer with a lifetime risk of 0.65% and sending 77% of women at some stage for colposcopy etc - that is a very bad deal for women, but great for profits for the medical profession. The referral rate in the States is even higher and you have huge numbers of excess investigations, women losing healthy ovaries after false positive pelvic exams and 1 in 3 will eventually have a hysterectomy by age 60, many/most are unnecessary.
The routine pelvic exam is of poor clinical value and exposes you to risk - it is not recommended in many countries in symptom-free women. I've never had one and I'm 54 - routine breast exams are not recommended either, they don't help, but lead to excess biopsies.
Your Dr Carolyn Westhoff has written some articles on this topic.
http://www.mailman.columbia.edu/academic-departments/epidemiology/research-service/routine-pelvic-examination-obsolete
The Pill - all you need is a blood pressure test and to provide your medical history.
http://www.managingcontraception.com/newsevents/dr-bob/pelvic-exam-necessary-for-contraception-rx/
I guess I have been lucky. I've always had a good doctor even though I've gone to about 100 different ones. I go through the uncomfortable to prevent anything I can. I know FAR to many women who found out they had cancer because they actually went in to have a pelvic exam.
Less invasive? Do you know what a male goes though for a prostate exam? what you go through for a colonoscopy? mammograms? it MUST be invasive to find cancer.
This is untrue, I'd urge women to look at what's happening in other countries. American women have been subjected to extreme and reckless over-screening and only now are your doctors being pulled up. Mass pap testing is yesterday's science, HPV primary triage testing is the better test, smarter test.
Your doctors fearing more women will have investigations with HPV testing is astonishing...only 5% of women are positive for HPV at age 30, the problem is they want to keep testing young women, even though pap testing does not change the tiny death rate in women under 30, but young women produce the most false positives which can lead to potentially harmful biopsies and over-treatment. HPV testing is also not recommended in those under 30, the virus is more common and is usually cleared in a year or so. So many countries protect their young women and don't test them, it doesn't help, but causes a lot of harm.
The Finns and Dutch have 7 pap test programs, 5 yearly from 30 to 60 and the Finns have the lowest rates of cc in the world and send far fewer women for colposcopy/biopsies etc
The Dutch are about to move to 5 hrHPV primary triage tests offered at 30,35,40,50 and 60 and ONLY those positive and at risk from cc will be offered a 5 yearly pap test. There is also a reliable self-test option for HPV called the Delphi Screener, being used by the Dutch and recently introduced into several other countries. Those negative and not at risk from cc, don't need pap tests, they will be offered the HPV program and test a total of 5 times. If negative, monogamous or no longer sexually active you can forget all testing and revisit the subject if your risk profile changes. This will greatly reduce pap testing, false positives, over-treatment and is more likely to prevent these rare cancers including the ones missed by pap testing - 50% of adenocarcinoma and 25% of squamous cell. The pap picks up 50 to 80% of high grade lesions, HPV testing picks up 98%....
With pap testing huge numbers of women end up with false positives and are referred, HPV testing identifies the 5% at risk who have a small chance of benefiting from pap testing, it also better protects the 95% who cannot be helped by pap testing....the argument made in this article makes no sense as far more women are referred with mass pap testing, including huge numbers of HPV negative women not even at risk from this cancer. I believe we need to do our own research and be careful, pap testing has generated vast profits for doctors and others and they will be reluctant to give that up and put women first. As a low risk woman my risk from cc is near zero, I passed on pap testing more than 25 years ago...the risks were too high for me. The lifetime risk of cc is 0.65% - there was never a need to harm so many healthy women, but now with HPV primary triage testing and the Delphi Screener there is no excuse...we can finally reduce the horrible testing burden on HPV negative women, not at risk... and can identify the small subset of HPV positive women who have a small chance of benefiting from pap testing. Women should demand smarter testing...there is enormous misinformation in this area due to the influence and power of vested interests. The pap testing/over-treatment industry is worth billions...It is not in their interests to identify the 5%, they'd rather say all women are at risk, which is not true, now we can identify those women at risk and leave the rest alone!