Pap test still best screen for cervical cancer

January 25, 2000|By Mark DePaolis

LET ME start by answering the question that all of you -- well, at least half of you -- are dying to ask: not yet. I've been saying this for two weeks now, ever since news reports were released about a new test that might one day replace Pap smears.

Almost every woman I've seen for a checkup has asked, "When's that new Pap smear test coming out?" Pap smears are important to everyone, except for the ones who are male and have no idea what I'm talking about. Women, on the other hand, were quick to respond to the news, and the response was "Yeah!"

January is Cervical Cancer Awareness Month. I think it's safe to say that women are aware. Many women have been following the reports of the new, more user-friendly tests, which may eventually replace Pap smears, closer than their husbands were following the NFL playoffs. You can cure the common cold or discover a new way to prevent heart attacks, but find a new test that will let women stop having Pap smears and they will consider this the greatest achievement in the history of Western medicine.

Earlier this month a team of doctors released a report saying that a new screening test is just as accurate as Pap smears in detecting cervical cancer. The study was performed by a Dr. Thomas Wright, who is presumably a man and has no vested interest in eliminating Pap smears forever, in an area of South Africa where many women have no access to regular medical care.

A similar study was done by Dr. Attila T. Lorinez, who I figure has about a 50/50 chance of being male, in Costa Rica. The test looks for DNA evidence of the human papilloma virus, which is believed to cause cervical cancer. Using this method, researchers were able to identify more than 80 percent of the women with cervical cancer, better than Pap smears could do.

More importantly, the test is done using a highly specialized medical instrument called a "Q-tip." Women can easily use this instrument to collect a sample for the test, essentially checking themselves for the virus.

The current method is much more involved, often requiring a piece of specialized medical equipment called a "doctor." It requires lying undressed in a small, chilly room on a paper-covered examination table while a medical provider -- usually male -- comes into the room fully dressed and prepares to insert an expanding metal device into your body under the glare of a high-intensity lamp. Then he tells you to "relax."

Despite these drawbacks, the Pap smear has been one of the biggest success stories in medicine. It's hard to remember this in the flood of bad-news medical research we hear every day ("New evidence proves that new evidence causes cancer"), but Pap smears have made a tremendous difference. The rates of fatal cervical cancer have plummeted ever since women starting having regular Pap tests. These days the people who die of cervical cancer are, by and large, the ones who have not had regular Pap smears.

This shows how men and women are different. Many women have been coming for screening checkups every year, year after year. They don't like it, but they come because they know it's important. Men don't like going to the doctor, so they don't, not unless someone makes them.

It never seemed fair that women had to go to the doctor every year, while men would come basically whenever they started a new job.

You can see why women are excited about the new test. A simple procedure like this can even be done at home. This would never have worked the old way. You would have needed metal stirrups on your sofa.

But the study showed that, while the tests done by providers were the best, the tests women did on themselves were more accurate than Pap smears, with more chance of identifying abnormal cervical cells.

I know -- it would be great if this new test really could replace Pap smears. It would mean better testing, with no appointments, no paper gowns, no menacing devices and no doctor. But for now, it's still just an experiment, and no one is using the new test for checking regular people like you. Like I said: not yet.

It could be years, so don't wait -- keep having regular Pap smears, just like you always have. And while I can think of many good reasons to move to Costa Rica -- especially in January -- this is not one of them.

Mark DePaolis is a writer and family physician who practices in Minneapolis.

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