On a recent episode of The Dr. Oz Show, Dr. Oz introduces special guests Jennifer Ashton, MD—a board certified gynecologist; and, Dianne Harper, MD, MPH--an HPV expert, for a show about the lesser-known facts of HPV and Pap smear tests that every woman needs to know.
Dr. Oz opens the show with a testimony by a woman named Michelle in her mid-30’s who decided it was time to have a baby with her husband of five years. She told viewers that she had taken a Pap smear regularly for years and that all test results showed no abnormalities. However, during a physical exam before becoming pregnant, her physician gave her an HPV (human papilloma virus) test and told her that she tested positive and was at risk of developing cervical cancer.
As it turns out, Michelle’s story is one shared by many women—an unexpected diagnosis of HPV infection.
“How could so many women like Michelle have normal Pap smears, but yet still have the HPV virus in there?” Dr. Oz asks Dr. Ashton.
“A Pap smear is an important test, and the Pap smear has saved lives from cervical cancer. Is a Pap smear a perfect test? Absolutely not,” says Dr. Jennifer Ashton. “Sometimes the cancer or pre-cancer is above the area that is swabbed by the Pap smear brush…it’s not perfect,” she said explaining that a Pap smear is typically done with a small-ended brush or spatula-like instrument that scrapes a small sample of cells from the outer surface of the cervix, but that it is not perfect for finding all abnormal cells.
When asked by Dr. Oz how do physicians reconcile the recent move toward fewer Pap smear exams in light of HPV and the risk of cervical cancer, Dr. Harper explains that it has to do with the length of time it takes for a pre-cancerous lesion due to HPV to develop into a cancer.
“What we know is that you have to have an HPV infection for a cervical cancer to develop. And the usual time frame for that cancer to develop is at least 3 to 5 years for it to become a cancer,” says Dr. Dianne Harper. “That is why if you screen every year, you are really over-screening. So, what we try to do is move that interval out to a longer interval that is safe, that tells us her risk of developing a pre-cancer lesion is still below 5 in 1,000, which is still a low risk of developing cervical cancer…so we can safely pull out that interval for a Pap test. And, if we add an HPV test to it, we can pull that interval out to 5 years before the risk jumps up a little higher.”
Dr. Oz’s guests explain that part of the problem is that many women are not aware what the differences are between a Pap smear test and an HPV test and/or whether an HPV test is available and if they should be tested.
Dr. Harper explains that while both tests require scraping of cells from the cervix, how the cells are then analyzed differs. With a Pap smear test, the cells are spread out on a glass side like a piece of art work for a pathologist to look at and make the call as to whether any of the cells appear abnormal. The HPV test involves taking the same cells from the smear and breaking them up to isolate the DNA to analyze the DNA for the presence of HPV.
So, when and how often should a woman have a Pap smear and HPV test?
“If you are over age 30, until about 65 years of age…and you go in for a Pap test anyway, you ought to be doing the following things,” says Dr. Oz. “Ask your doctor about having an HPV test the same time [as your Pap test], and if you don’t have HPV on your results, that means you can delay your next Pap test for 5 years instead of the normal three.”
Dr. Ashton concurs with Dr. Oz, but adds the warning that women should understand that this does not mean that they should also forego seeing their gynecologist on a yearly basis for a regular pelvic exam based on a negative Pap and negative HPV test results.
“You should see your gynecologist every year,” states Dr. Ashton.
Dr. Ashton also tells viewers that there is a new test that can be used both for a Pap smear and HPV detection.
“There’s actually a test called a “Cobas test,” which can do a Pap, the high risk HPV type, and the particularly high risk for cervical cancer HPV 16 and 18 type, off of one specimen. One visit to the doctor, one specimen, not a million brushes in a vagina, not a million visits,” says Dr. Ashton.
The cobas® HPV test is an FDA approved test for women that specifically identifies HPV types 16 and 18 while concurrently detecting the rest of the high risk types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68) at clinically relevant infection levels from cells scraped from the cervix during an exam.
The value of the cobas® HPV test is that it can determine whether a woman is infected with one of the few subtypes of HPV responsible for cervical cancer, or with one of the majority of other subtypes that are not linked to cervical cancer.
To find out what the recommended age is for the HPV vaccine for minors, follow this link to an article that explains why fears of having your child vaccinated leads to early teen sexual activity are unfounded.
Image Source: Courtesy of Wikipedia
Reference: The Dr. Oz Show “The HPV Test That Could Save Your Life”