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Possible Good News About Dreaded PAP Test

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 40 in the October 17, 2012 issue of
The Mississauga News under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

One of the dreaded rights of passage for many mature women is having their physical examination accompanied by that dreaded pelvic examination and PAP. Even as medical students, we dreaded the thought of using those cold steel speculums that were used once. Moving into the modern era saw the advent of comfortable disposable plastic speculums and new techniques to streamline the process.

There is even more great news in the works. Cancer Care Ontario is in the process of releasing new Ontario guidelines that should put more smiles into the equation. Blood testing for human papillomavirus DNA is being considered as the primary screening technique for cervical cancer. It is not yet OHIP funded and is not part of the regular physical bloodwork. The idea is to start screening at age 21, and repeat the blood test every three years through age 70. The blood test is still having some accuracy problems that are being worked out. Women below age 21 who are not sexually active do not need screening until they become active.

There are dozens of various HPV (Human Papilloma Viruses) floating around. Only type 16 and 18 have been implicated with Cervical Cancer while type 9 and 11 cause most of the unsightly genital warts. There is more evidence growing that suggests throat cancers, anal cancers and penile cancers are associated with the HPV virus, which is why the vaccine may benefit men as well.

In almost 90% of young women,the HPV virus is cleared by the immune system within 2 years of initial infection. The new guidelines are based on some new evidence that suggests the HPV blood test, which identifies DNA from the 16 and 18 viruses, is slightly better than having a traditional PAP test that uses a small plastic brush to gather cells from the cervix.

The traditional PAP test would then only be used for anyone whose blood test is positive. Having the virus does not mean you will get cervical cancer, but monitoring the cells from the cervix to look for those first changes would be crucial to both prevention and treatment. Women age 70 who are in a stable relationship and whose 3 last tests were normal would no longer need screening.

This represents a very large shift from the current traditional thinking. This data also supports the current HPV immunization program that consists of 3 shots given to girls in Grade 8. The clinical reality is still some time away, and it is doubtful that the pelvic exam will be eliminated altogether, because it is used to asses many other things such as ovarian masses, size of the uterus, unusual lesions, bladder and hemorrhoid problems etc. But, the younger patients may be overjoyed with this news.

Related resources:

Cervical Cancer Screening. Public Information from Ministry of Health and Long-Term Care (MOHLTC).

Human papillomavirus. Human papillomavirus (HPV) is a virus from the papillomavirus family that is capable of infecting humans, from Wikipedia, the free encyclopedia.

Sexually Transmitted Diseases (STDs): Genital HPV Infection - Fact Sheet from Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Prevention.

What is genital HPV infection? Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 HPV types that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat. Most people who become infected with HPV do not even know they have it.

HPV is not the same as herpes or HIV (the virus that causes AIDS).

Human Papilloma Virus (HPV) from University of Victoria, Canada. The Human Papilloma Virus (HPV) is the most common sexually transmitted infection today. There are over 100 different strains of HPV.

Human papillomavirus (HPV) and genital warts fact sheet from Women's Health.

Facts about HPV from McGill University. How is HPV transmitted? What are the signs and symptoms of HPV? Is there a cure? What are the latest medical advancements for HPV prevention? ...

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