Age mat­ters when it comes to screen­ing for cer­vi­cal can­cer

The Mercury News - - Other Views - By Lau­ran Neer­gaard

Get­ting checked for cer­vi­cal can­cer isn’t one-size-fits-all: Mil­lions of women may soon have to de­cide be­tween a rou­tine Pap or a newer test that de­tects if they have a can­cer-caus­ing virus.

Draft na­tional guide­lines re­leased Tues­day for the first time say ei­ther op­tion is rea­son­able for cer­tain women — those ages 30 to 65.

Paps, a main­stay for women’s health for decades, can spot pre-can­cer­ous ab­nor­mal­i­ties in time to pre­vent can­cer. Newer HPV tests de­tect the virus that causes nearly all of that can­cer, and while they’re widely used to con­firm Pap re­sults, most U.S. med­i­cal groups haven’t yet pushed them as a stand­alone al­ter­na­tive for screen­ing.

Tues­day’s pro­posal doesn’t sig­nal an im­mi­nent end to the Pap era. Paps, not HPV tests, still are rec­om­mended for screen­ing women in their 20s, stressed the guide­lines from the U.S. Preven­tive Ser­vices Task Force.

And don’t let the which-test de­bate blur the main mes­sage: “Screen­ing for cer­vi­cal can­cer saves lives,” Task Force mem­ber Dr. Carol Man­gione of UCLA said.

To­day, too many women still miss out. Some things to know:

Still a threat

Cer­vi­cal can­cer has dropped dra­mat­i­cally over the past half-cen­tury thanks to Pap test­ing. Still, this year an es­ti­mated 12,820 U.S. women will be di­ag­nosed with cer­vi­cal can­cer, and about 4,200 will die. Most haven’t been screened, or have gone too long be­tween checks.

Paps ex­am­ine cells scraped from the cervix. HPV test­ing looks for high­risk strains of the hu­man pa­pil­lo­mavirus, the na­tion’s most com­mon sex­u­ally trans­mit­ted in­fec­tion. Ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Preven­tion, just about ev­ery­one will get at least one strain at some point in their lives. But only cer­tain strains cause cer­vi­cal can­cer — and only if they linger long enough in the body.

Age mat­ters

Other­wise healthy women need a Pap ev­ery three years from age 21 to 29, agree most U.S. physi­cian groups and the draft Task Force guide­lines. Cer­vi­cal can­cer grows so slowly that reg­u­lar Paps can find a prob­lem early enough to treat.

While the Food and Drug Ad­min­is­tra­tion has ap­proved an HPV test for women as young as 25, na­tional guide­lines have long rec­om­mended Pap screen­ing for 20-some­things. That age group is most likely to get HPV — and the vast ma­jor­ity of the time their bod­ies clear the in­fec­tion be­fore it harms.

What changes at 30?

The older you get, the greater the chance that an HPV in­fec­tion is the years­long, harm­ful kind. To bet­ter catch those cases, to­day what’s called co-test­ing is in­creas­ingly com­mon for women 30 and over — a Pap-plus-HPV test com­bi­na­tion. If the re­sults of both tests are neg­a­tive, women can wait five years to test again.

But both Paps and HPV test­ing can trig­ger false alarms, prompt­ing un­needed, and some­times harm­ful, ad­di­tional care to rule out can­cer. New stud­ies show co-test­ing leads to more false alarms than ei­ther test alone, with­out adding ben­e­fit.

That spurred Tues­day’s Task Force pro­posal to let women 30 and over choose an HPV test by it­self ev­ery five years — or a Pap ev­ery three years in­stead. The pro­posal is open for pub­lic com­ment through Oct. 9, be­fore it will be fi­nal­ized.

Some coun­tries al­ready are mov­ing to make HPV test­ing the chief screen­ing tool, in­clud­ing the Nether­lands and Aus­tralia.

“Most ex­perts in this area are in agree­ment that HPV test­ing alone is the fu­ture of cer­vi­cal screen­ing,” said Deb­bie Saslow of the Amer­i­can Can­cer So­ci­ety, who wasn’t in­volved with Tues­day’s draft guide­lines.

Weigh pros and cons

Women in their 30s and older need to dis­cuss screen­ing op­tions with their health providers, said Dr. Ja­son Wright, gy­ne­co­logic on­col­ogy chief at New York-Pres­by­te­rian/Columbia Univer­sity Med­i­cal Cen­ter, who also wasn’t in­volved with the new guide­lines.

An HPV test can cost twice as much as a $40 Pap, but doesn’t re­quire screen­ing as of­ten. Some data sug­gest HPV test­ing leads to more di­ag­no­sis of risky pre-can­cer — but even by it­self, an HPV test can spark more false alarms than a Pap, Wright said.

Also, some fol­low-up tests can al­ter the cervix in ways that may af­fect fu­ture preg­nan­cies, a con­sid­er­a­tion for women still in­ter­ested in child­bear­ing, added the Task Force’s Man­gione.

Who can skip it?

It’s not rec­om­mended for women younger than 21, or those who had a cervix-re­mov­ing hys­terec­tomy.

Women can stop screen­ing af­ter age 65 if proper checks un­til then show they’re healthy, cur­rent guide­lines agree.

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