Does a pap smear make sense in the 21st century?
What should modern cervical cancer prevention look like?
Preventive vaccinations of girls and women before sexual intercourse play an important role. This is known as primary prevention. The benefits of vaccination are clear and result in a reduced number of HPV infections. Chronic HPV infection (especially types 16 and 18) is a major risk factor for cervical cancer.
The causal link between cervical cancer and chronic HPV infection has been shown to be stronger than the link between lung cancer and cigarette smoking.
However, it is worth remembering that vaccination does not exempt a woman from the need for other preventive tests, including a pap smear. There are several reasons for this, the first of which is that the vaccination does not cover all oncogenic types of the virus and despite so-called cross-immunity, the risk of cervical cancer also exists in the vaccinated woman.
What about women who have not been vaccinated?
For them, so-called secondary prevention is dedicated, which means performing screening tests that will help detect conditions that precede the onset of cervical cancer or cancer at an early stage. The 20th century was dominated by the pap smear, which, it is safe to say, saved millions of lives.
What are other tests for cervical diagnosis besides a pap test?
There have been tremendous recent technological advances in the field of diagnostic testing. Women often feel confused by the multitude of these tests, so I will try to explain a little bit about this complicated issue.
A test that is very useful is the HPV test. Typically testing genetic material of viruses with high oncogenic potential including 16 and 18, this swab is taken very similar to a pap smear.
A positive result means that the patient is in the risk group for cervical cancer, and this is extremely important information for the doctor, because from now on the diagnosis of this patient will be carried out completely differently. A positive result is very stressful for a woman, so it is important to make her aware that an infection does not automatically mean that she will get cervical cancer in the future, but only an increased risk.
It is extremely important to test the so-called Ki 67 and p 16 markers, which help to decide whether, in simple terms, the virus has caused irreversible damage to cells or if there is a chance that the infection will heal itself. The swab for testing these markers is taken exactly as for HPV, sometimes the markers are determined in tissue material from a cervical biopsy.
So does it still make sense to get a pap test?
Of course it does. A pap test still has many benefits. It is also a relatively inexpensive test compared to those discussed above. It is worth noting, however, that currently the recommended pap test is the so-called LBC, i.e. cytology on a liquid medium. A cervical swab is taken on a special medium and, if indicated, both the HPV test and the Ki 67 and p16 markers can be performed at the same time.
So what should a woman who wants to take care of her health do, what test should she choose?
Above all, in this modern flood of information, a doctor who specializes in a particular issue should help her take the right path.
As far as prophylactic management is concerned, co-testing is currently recommended, i.e. cytology LBC + HPV HR test for each patient. Of course, such a wide range of tests need not be repeated every year. The future may be that the pap test that all women are used to and basically everyone has heard of will not be a screening test and the HR HPV DNA test will be the one. Time will tell.