We know what pap testing looked like in the 50’s because on the surface not much has changed. Even though it has been 60 plus years since the introduction of pap tests to screen for cervical cancer, the stirrups are the same, the speculum is the same, and there is the same direction to “scoot down, just a bit more, now let your knees fall apart . . . that a girl”. But anyone who has been following this subject probably knows that a great deal has changed in regards to pap tests, even though these changes are not showing up in the doctor’s office. Given scientific advancements, new technology, clarification of legal and ethical issues, research and information sharing; here is what pap testing should look like today when a woman visits a doctor:
Doctor: Hi Sarah. What brings you in today?
Patient: I think I sprained my ankle when I was running, it’s kind of swollen and hurts when I’m walking . . .
Doctor: Well let’s take a look (doctor examines ankle and asks questions about pain, etc.)
Patient: What do you think?
Doctor: It should be supported and monitored (doctor wraps ankle and gives instructions for monitoring and care to patient). If it isn’t improving come back and see me. Are you having any other issues?
Patient: No, thanks . . . aren’t you going to ask me when my last pap test was?
Doctor: No, cervical cancer in young women is very rare and the pap test has poor specificity . . . research has found that it often leads to further testing that can cause damage to your cervix. The damage can then cause difficulties with pregnancy and giving birth, or can lead to further surgery. If you like, in a few years when you turn 30, you can provide a urine sample to test for HPV. If you test positive, and only about five percent of women test positive, then we could do a pap test.
Patient: Okay, thank you.
Doctor: You’re welcome. Take care of that ankle now . . . and come see me if it isn’t improving.
Patient: I will, thanks again! (Sarah leaves . . . happy, dignity intact . . . and feeling cared for)
A comparison of pap testing in the Netherlands (begins at age 30) with the United States: http://onlinelibrary.wiley.com/doi/10.1111/j.1468-0009.2011.00652.x/full
Balancing benefits and risks: http://online.liebertpub.com/doi/pdfplus/10.1089/jwh.2010.2349
Why doctor does not have pap smears: http://margaretmccartney.com/2012/03/20/why-i-dont-have-smears/
Common misconceptions: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2805%2978229-5/fulltext
Should we abandon pap testing: http://ajcp.ascpjournals.org/content/supplements/114/Suppl_1/S48.full.pdf
Urine test for HPV: http://www.trovagene.com/Products-Services/Clinical-Testing-Services/HPV.aspx
HPV testing for cervical cancer: http://www.telegraph.co.uk/health/healthnews/10118303/New-screening-test-cuts-cervical-cancer-cases-by-one-third.html