February 12, 2008
60 5th Avenue
New York, NY 10011-8868
To the Editor:
The undersigned medical associations are very concerned that Claire Cain Miller’s recent article, “The Cancer that Shouldn’t Be,” sends the wrong message to women about their health. The Pap test continues to be effective and represents the most basic element for screening programs designed to prevent or identify cervical cancer.
Neither the newly introduced cervical cancer vaccine nor the HPV test alone is enough to protect women. The HPV vaccine, as mentioned in the article, does not protect against all types of the human papillomavirus (HPV), leaving women vulnerable to the remaining cancer-causing HPV types. Further, the HPV vaccine may be less effective in women who have been previously infected with the types of HPV found in the vaccine, and therefore is most effective if given to women before the onset of sexual activity.
The HPV test, on the other hand, is a very sensitive test and identifies many women who are HPV positive. However, most of the detected cases represent only temporary infections that are unlikely to develop into cervical cancer. The HPV test, if used alone, may result in unnecessary treatment and anxiety for women when interpreted without the additional information provided by the Pap test. Maximum screening efficiency may be achieved when the tests are used together.
We recommend that for women over 30 it is appropriate to have both the Pap test and the HPV test. Using both tests for women in this age group increases the chances for identifying precancerous changes. Other screening options for women over 30 include getting an annual Pap test alone or being screened every 2-3 years if they have had three or more normal annual Pap tests. For women under 30, it is still most appropriate to have just an annual Pap test for routine screening. Because HPV infection is quite common in younger women but usually clears up on its own in one to two years, the value of HPV testing for screening women under 30 is limited.
Obstetrician-gynecologists and other women’s health care practitioners who provide cervical cancer screening services; pathologists, the doctors who diagnose cervical cancer, precancerous lesions, and other HPV related diseases; and cytotechnologists, the technologists who evaluate and interpret such tests, understand that regular Pap tests save lives. While new medical developments such as the HPV vaccine and the advent of the HPV test are exciting and useful among some populations, it is important for women to know that the Pap test remains the best way to detect abnormal cells on the cervix and thus help prevent cervical cancer.
Jared N. Schwartz, MD, PhD, FCAP
President, College of American Pathologists
Dina R. Mody, MD
President, American Society of Cytopathology
Lee H. Hilborne, MD, MPH, DLM(ASCP)CM, FASCP, FCAP
President, American Society for Clinical Pathology
Hal C. Lawrence, III, MD
Vice President, Practice Activities, American College of Obstetricians and Gynecologists