Goodbye, Pap smear! Hello, Cervical screening test!

I’ve been meaning to write about this for a while but things keep coming up!

Enjoying a few days in the country side and have some much needed time on my hands. There’s something in the country air which is immensely relaxing and calming, which puts things in perspective a bit, makes you realise there’s more to life than reaching daily goalposts, getting to places and meeting deadlines. Quiet clean air, birds chirping, leaves rustling in the soft warm wind of the summer, water flowing gently in the river …. ahhh bliss!

Anyway, back to the equally calming (not!) topic of the Pap smears. So, Australian health system has decided to bid adieu to the good old Pap smears.

All of you will know that Pap smear has been the universally accepted method of screening for cervical cancer in women and has been around for ages, since WW II to be precise.  An interesting fact about this test is that its named after it’s inventor, a Greek American pathologist, Dr George Nicholas Papanikolaou, who started his research in the area of trying to find a non invasive test to diagnose uterine cancer through sweeping some cells from neck of the womb. He started working on this around 1923 and it wasn’t until 1943 that he was able to publish the groundbreaking work ” diagnosis of uterine cancer by the vaginal smear” which made his work known far and wide and the method became universally acceptable.  So for over 20 years of his life this pioneer worked on methods to describe the cell changes that occur in the cells of cervix in cancer, how to prepare the slides to collect a good sample etc. All through these years he apparently fought the scepticism of medical fraternity which initially rejected the idea as being ludicrous! History states that one of the most crucial contributors in his work were his patients with uterine cancer who allowed him to experiment by taking samples from their cervix and study. None of the scientific work we do, the big discoveries that are made will ever be possible without the contribution from the patients themselves. So anytime a patient asks me about my opinion about participating in a scientific study I’m encouraging about them being an invaluable part of a possible life changing experiment for millions, for many generations to come, as we have seen in the case of Pap test.

Pap test has been based on the principle of taking a sample of cells from the cervix(neck of the womb) by the health care professional trained in doing this procedure and preparing a slide from it. The slide then makes its journey to the lab where the pathologists study it for any changes that are a deviation from the normal cells. If there are no changes then its obviously a normal study but if there are any changes then they are further put into various categories, ranging from possible small changes to highly abnormal, suggesting the ultimate bad guy, cervical cancer.

It’s now well known that all of these changes, whether small or more significant, occur due to a virus named HPV – Human Papilloma Virus.

So the key change that is happening in replacing Pap smear with cervical screening test (CST) is that Pap smears used to rely on picking up the cell changes that had already occurred ( the effect of the virus) and the new cervical screening test relies on picking up the virus itself ( the cause of all cell changes in the cervix).

This has changed the landscape of the screening test as we are no longer waiting to check  and assess the extent of the damage done by the virus but we are targeting the virus itself.

This makes CST a far superior test as its picking up the problem (virus) before it has become a problem (cell changes).

This is where the beauty of this test comes in,  which I am sure will appeal to almost all women : due to its superiority in picking up the pathogen itself, a negative test means that you don’t have to have another screening test for five years!

The reasoning behind this is cervical cancer is a pretty slow growing cancer. I remember being taught at med school that for a nasty subtype of virus to make home in the cervix and for it to grow to full blown cancer, it can take unto ten years – this is the theory behind the safety in leaving these long periods in women who don’t have the virus.

So, lets say you have a normal CST and get an all clear for 5 years, then you get exposed to the virus unbeknownst to you and you remain without any symptoms then the virus wouldn’t have had enough time to cause any serious damage by the time you have the next test.

But if on the other hand, you do start having any symptoms such as irregular vaginal bleeding, particularly in between periods or after intercourse, then you should see your doctor, regardless of the last test being negative, as then your doctor may decide to undertake some further tests.

Coming back to the root cause of all this problem and the conversation about cervical cancer and the need for a robust screening program – HPV. Its not a single virus but a whole family – with about 170 known members so far. Not much unlike our human families! Some members of the family are quite benign and cause no symptoms and resolve by themselves without needing any intervention, some are pesky and linger for a bit and can cause warts or precancerous changes which can then lead to cancerous changes. Nearly all cancerous changes are due to 2 subtypes, HPV16 and HPV18 which account for about 70% of all cases. CST can’t pick up all the virus members but looks for the problem ones, which tend to be the troublemakers and are our concern anyway.

The other difference with the new screening test is the age. Previously it was 20 yrs to 70 yrs of age whereas now it starts at 25 and goes upto 74 yrs.

The start age for the screening may seem somewhat late from what to used to be but like most other scientifically backed programs, that has logical reasoning too. And the reasons are:

a) HPV vaccination has changed the landscape a lot. It’s able to provide significant protection, provided its administered prior to the onset of sexual activity. Hence the drive to vaccinate young people whilst they are still at school – it sets them up with the best possible protection for the rest of their lives;

b) Younger people have sturdy immunity and most youngsters are able to clear the virus by themselves without needing any intervention.

But what about people who are in the age group 20-25 yrs and had already started the Pap smears under the old screening program? Well, if their last smear test was normal they will get notification from National Cervical Screening Registry when their first CST should be done to get them integrated into the new screening program. If there last Pap smear was abnormal then they should continue to follow the advice they received from their doctor regarding follow up intervals.

Lots of information here! Please remember this is quite general advice and your circumstances may be different based on your own health, lifestyle etc. So make sure you take the opportunity to have a discussion with your health care professional about your screening test as they’ll be best placed to guide you in the right direction.

Happy screening!

 

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