Family physicians remind women why pap tests still important

For The Journal

Published Monday, April 30, 2007

While news of a vaccine to prevent cervical cancer is an exciting development in women's health care, Minnesota family physicians are reminding patients that it doesn't make Pap tests — a procedure designed to check for signs of the disease — any less important.

That's because the vaccine doesn't protect against all types of the genital Human Papillomavirus or HPV, the root cause of all cervical cancers. Also, the vaccine is currently only approved for younger females.

"A Pap test is a simple and effective way to screen for a possible problem," Park Nicollet-Brookdale M.D. and family physician Amy Bonifas said. “As physicians we hope the new vaccine means we’ll see a growing number of patients who have normal Pap test results. We also want to be assured that the female population understands that regular Pap tests are still a necessary tool to detect any abnormal cells that could lead to cancer."

According to the Centers for Disease Control and Prevention, genital HPV is the most common sexually-transmitted infection in the country, with more than 6.2 million new cases being reported each year. And while it is a major risk factor for cervical cancer, in most cases, a women's immune system will suppress or eliminate the infection on its own.

However, in some women, the virus can survive for years causing the cells on their cervix to change. A Pap test, in which a doctor takes a sample of cells from the cervix, can detect these abnormal cells before they become life-threatening.

"Women with early cervical cancer or pre-cancer don't usually have symptoms," Dr. Bonifas said. "Signs of the disease, such as unusual discharge or bleeding, don't typically show up until the cancer has progressed. That’s why it’s so important for women to have regular Pap tests."

Widespread use of Pap tests has dramatically reduced the incidences of invasive cervical cancer in the United States. That's because, if caught early, cervical cancer can often be cured. Yet, not all women get regular Pap tests.

The American Cancer Society predicts that there will be more than 11,000 cases of invasive cervical cancer-diagnosed in American women in 2007, and nearly 3,700 women will die of the disease this year.

"An abnormal Pap test doesn't mean a patient has cancer, but it will alert their doctor that more testing is needed," Dr. Bonifas said.

A patient with abnormal cervical cells related to HPV may be examined using a special magnifying lens called a colposcope and also have a biopsy of her cervical tissue. If cancer cells or high grade pre-cancer cells are found, treatment options will be discussed. In other cases, a patient will be watched closely by her doctor.

Because there is no drug treatment to rid the body of HPV at this time, women with the infection must have more frequent Pap tests.

The HPV vaccine, Gardasil, was first approved by the Food and Drug Administration in June 2006. It is recommended for girls/women nine to 26 years old and ideally should be given to females before they are sexually active. The Advisory Committee on Immunization Practices (ACIP) recommends that Gardasil be routinely given to girls ages 11 to 12.

The vaccine is designed to protect against four genital HPV types which together cause 70 percent of cervical cancers and 90 percent of genital warts. It’s given in a series of three injections over a six-month period.

Another HPV vaccine, Cervarix, is in the final stages of clinical testing, but it is not yet licensed. This vaccine would protect against the two types of HPV that cause most cervical cancers. The length of vaccine protection is not yet known, but so far studies have found that those who have been vaccinated are protected for four to five years. Additional research is being done to find out if a booster dose of vaccine will be needed to maintain immunity.

"The medical community is encouraged by a vaccine that will prevent cancer,” Dr. Bonifas said. "We just want to make sure the public has as much information as possible. Patients with questions about HPV, Pap tests and the new vaccine should definitely talk with their family doctor."