- Many women believe Pap tests detect gynecological cancers
- But experts warn HPV tests are better at catching cervical cancer
- And it is incredibly rare that Pap smears can detect ovarian cancer
- Here we explain why some countries are switching wholesale from Pap to HPV testing as the standard, and what other tests you should be aware of
It has been the staple of women’s healthcare for years.
From the age of 21, all females in the US are advised to start getting annual Pap tests.
The painless exam – placing a Q-tip inside the woman’s cervix to take a sample – is the standard way to check for cervical cancer.
However, a growing swell of research suggests this method is too outdated and non-specific to be relied on.
Experts argue America should follow the Netherlands and Australia in dropping the Pap test in favor of HPV tests, now that we know most cervical cancers are caused by the sexually-transmitted disease.
But some claim even that is not enough.
The American Cancer Society has repeatedly warned that many women seem to believe a Pap test is a one-size-fits-all exam that catches any kind of cancer.
However, they warn ‘silent killer’ ovarian cancer is rarely spotted with anything other than a transvaginal ultrasound or a CA-125 blood test.
Experts warn the Pap test is too flawed to be a woman’s only test for ‘silent killer’ cancers
WHAT IS THE PAP TEST?
The Pap test is named after Greek-American Dr Georges Papanicolaou, who developed the revolutionary method of scraping cells from the cervix in the 40s.
In his method, he would smear them on a glass slide and then examine them under a microscope to detect pre-cancerous changes.
In recent years the method changed, so it is now put in a test tube, meaning the name technically changed from ‘smear’ to ‘test’.
The test was the first exam that could be used for screening women to prevent cervical cancer.
And since routine tests were introduced, the number of cases of cervical cancer plummeted.
Unlike many other cancers, cervical cancer does not develop suddenly.
Instead, the cells change gradually over many months or, in some cases, several years.
Therefore, detection at an early stage allows the abnormal cells to be destroyed relatively easily, before they have a chance to develop into full-blown cancer.
The Pap test is a painless exam – placing a Q-tip inside the cervix to take a sample – to check for cervical cancer. It was invented in the 40s, when we didn’t know what caused cervical cancer
WHY DO SOME SAY IT IS FLAWED?
1. IT CANNOT DETECT OVARIAN CANCER – BUT MANY THINK IT CAN
The American Cancer Society noted that it is difficult ‘for even the most skilled practitioner’ to identify ovarian tumors with a Pap test – either in the early or late stages.
Usually, a gynecologist will also do a pelvic exam as well, feeling for enlarged organs.
However, the ACS warns that this method is also flawed, saying it is rare that doctors could feel ovarian tumors by hand.
The only sure-fire way of catching ovarian cancer is by using one of two tests: a transvaginal ultrasound and a CA-125 blood test.
Those tests are two of the best options out there – though neither is completely accurate.
The transvaginal ultrasound uses sound waves to look at the uterus, fallopian tubes and ovaries through an ultrasound wand.
That test can find a mass in the ovary – though it cannot tell if it is cancer or not.
In contrast, the second test detects levels of the protein CA-125 in the blood.
For women with ovarian cancers, their CA-125 levels are often high.
But, other conditions can also cause CA-125 levels to be abnormal – and not every woman with ovarian cancer has high levels.
That’s why regular transvaginal ultrasounds and CA-125 tests are not recommended.
2. THE TEST IS BASICALLY A WAY OF LOOKING FOR HPV
When the Pap was invented, nobody knew what caused cervical cancer.
The test was a general way of detecting ‘abnormal’ cells – i.e.: cells that don’t look exactly as they should.
Today, we know that 91 percent of those changes – leading to cervical cancer – are caused by HPV.
HPV is also the reason for 75 percent of vagina cancers and 69 percent of vulva cancers.
As a result, we now know that the Pap’s purpose is almost always to detect HPV.
Indeed, current research indicates that the only way you can by 97 percent sure of catching cervical cancer (the highest probability) is by teaming the Pap with an HPV test.
HPV is a common virus that causes warts, including genital warts. Usually, the immune system clears the infection, but persistent infection with certain strains of HPV leads to cervical cancer in some women.
Today, we know that 91 percent of those changes – leading to cervical cancer – are caused by HPV. In other words, the purpose of the Pap test (pictured) is almost always to detect HPV
SHOULD WE SWAP IT FOR A COMBO OF HPV TESTS AND ULTRASOUNDS?
1. THE ARGUMENT FOR HPV TESTING AS THE STANDARD METHOD
HPV tests are more accurate than Pap tests at testing for the DNA of HPV.
Some tests specifically focus on HPV types 16 and 18 – the ones most associated with cancer.
Those who back the switch emphasize the savings it would earn patients: they could skip the co-pay of both Pap smears and HPV tests. They could also do the test at home.
Indeed, there is a global push to switch from Pap tests to HPV tests as the standard check for cancer.
Holland made the change last year, and Australia is switching by the end of 2017.
2. THE ARGUMENT AGAINST
In America, there is still push-back, given the high rates of false-positives.
Eighty percent of sexually-active Americans will contract HPV at some point in their lives. But in most cases, the virus goes away on its own and doesn’t develop into cancer.
In 2011, the U.S. Preventive Services Task Force said that after reviewing all the clinical data, they would recommend against HPV tests, alone or in combination with smear tests in women under 30.
They said that screening for HPV causes more false positive cancer results than the smear alone.
However, they said there wasn’t enough evidence to decide whether the HPV tests did more harm than good in women over 30.
The panel, which is highly influential in primary care practice in America, said women should just have a smear test once every three years between the ages of 21 and 65.
The scientists must weigh the potential benefits of early detection of disease through screenings against the potential harms to healthy patients who may be subjected unnecessarily to more invasive procedures or side-effects.
EXPLAINED: THE 5 GYNECOLOGICAL CANCERS AND HOW TO FIND THEM
1. ENDOMETRIAL CANCER
Endometrial cancer, also called uterine or womb cancer, starts in the lining of the uterus.
It can spread, infecting the cervix, the outer lining of the womb, the ovaries, the fallopian tubes, the vagina, and the vulva.
Most sufferers will experience some tell-tale symptoms before the cancer develops, allowing it to be caught early.
However, unlike cervical cancer, standard tests (like pelvic exams and Pap tests) do not easily detect endometrial cancer.
The majority of women diagnosed with endometrial cancer (about 90 percent) have abnormal vaginal bleeding.
Some may experience a change in their periods (from heavy to light or vice versa), bleeding between periods, bleeding after menopause, or discharge tinted with blood.
These symptoms are not specific to cancer, but doctors advised seeing an ob-gyn to be safe.
Meanwhile some women may not see blood in their discharge, but rather a change in consistency. This should also be a warning sign, the American Cancer Society warns.
Other symptoms include pelvic pain and inexplicably losing weight.
As with many other cancers, if you feel a lump or mass, you should see your doctor.
Women most at-risk of contracting endometrial cancer are over 55, in late menopause, have never given birth, are infertile, are obese, have diabetes, have high blood pressure, or are on estrogen treatment or tamoxifen therapy.
An ultrasound is the most common test to detect endometrial cancer.
The next step is an endometrial biopsy, removing a piece of endometrium using a suction tube, to be tested.
In the case of a cancer diagnosis, CT, MRI and PET scans can then be used to see whether the disease has spread.
Finally blood tests can be carried out to detect whether a woman has a decreased blood count, since the cancer can cause anemia.
Treatments include surgery to remove the uterus, radiation therapy, and chemotherapy.
2. OVARIAN CANCER
Ovarian cancer is where the disease originates from the cells in and around the ovary.
The ovaries form part of a woman’s reproductive system, storing her supply of eggs.
Each month an egg is released into the womb, ready for fertilization.
Ovarian cancer is the fifth most common cause of cancer death in women and accounts for more deaths in the UK than all of the other gynecological cancers combined.
If diagnosed at an early stage, the outcome is good.
However, because some of the symptoms of ovarian cancer are similar to those seen in more common conditions, it can be difficult to diagnose.
As a result, vast swathes of patients are not diagnosed until the disease has spread, increasing the likelihood they will succumb to the disease.
In addition, it is important to note, most tumors found on the ovaries are not cancerous, but benign.
One in five ovarian masses found in women still having their periods are cancerous.
That figure rises in post-menopausal women to one in every two tumors.
In the majority of cases, ovarian cancer affects women over the age of 50.
The key early signs and symptoms to be aware of are:
These symptoms should raise concerns if they are frequent (happen more than 12 times a month), are persistent and new, not normal for you.
It is likely that these symptoms may not be a sign of ovarian cancer, but many patients experience the symptoms in the early stages of their disease.
Approximately one in every two women will develop ovarian cancer in their lifetime.
Though the cause of the disease isn’t yet properly understood, age and having a family history of ovarian cancer, increases a woman’s risk.
Two in 10 cases are thought to be linked to the inherited ‘faulty’ BRCA gene.
Carriers of the faulty BRCA1 or BRCA2 genes, like Hollywood star Angelina Jolie, are also at greater risk of developing breast cancer.
3. CERVICAL CANCER
Cancer of the cervix – the neck of the womb – affects women of all ages, but is most common in those aged 30 to 45 years old.
The disease is largely preventable, with screening programs where women have regular smear tests, detecting pre-cancerous cell, which indicate an increased risk of cancer if they remain untreated.
In the future the HPV vaccine will prevent most forms of cervical cancer, but until a time when all women have had the vaccination, screening will remain to play a vitally important role.
As with all gynecological cancers, the sooner cervical cancer is diagnosed, the better a woman’s chances of survival.
Important early symptoms are:
Nearly all cervical cancers are caused by the common, sexually transmitted infection, the human papillomavirus (HPV).
Most women will have HPV at some point in their lives, though for most the virus clears up of its own accord.
But, where the virus doesn’t go away, there is a risk of abnormal cells developing, which could morph into cancer over time.
To lessen the risk of developing the disease
Even if you have had the HPV vaccine and have a normal cervical smear result, it is vital you raise symptoms with a doctor.
4. VULVAL CANCER
Vulvar cancer is one of the rarest forms of the disease, with around 1,000 cases diagnosed in the UK each year.
Eighty per cent of those are in women aged over 60, while the pre-cancerous form of the condition – vulval intrepithelial neoplasia – tends to be diagnosed in those aged 30 to 50.
Symptoms of vulval cancer include:
While all these symptoms can also be a sign of other, more common conditions, it is vital to see your GP if any persist.
The HPV vaccine is among the greatest protection available to the disease, as many forms of vulval cancer are triggered by the virus.
5. VAGINAL CANCER
Vaginal cancer is a very rare form of the disease, with just 250 cases diagnosed in the UK each year, according to The Eve Appeal.
As with all gynecological cancers, it is most common in older women, in this case those over 60, while it is extremely rare in those aged under 40.
A condition called vaginal intrepithelial neoplasia, where there are changes to the cells in the lining of the vagina, can mean you’re at increased risk of the disease.
The condition only triggers cancer where it is not treated.
Cervical screening smear tests can help detect any changes in the cells in the lining of the woman.
And the HPV vaccine offers protection as vaginal cancer can be caused by the HPV virus.
Early symptoms of vaginal cancer are:
As many as one in two women with vaginal cancer will have no symptoms at all.