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Are Pap Smears a Thing of the Past?

Cervical cancer used to be one of the top causes of cancer for women in this country. But over the past decade, rates have declined. This has led the American Cancer Society to update its guidelines about when women should begin screening.

The new guidelines recommend against continued use of the Pap test, suggesting instead that women ages 25 to 65 have HPV testing every five years, and advise against screening altogether for women younger than 21.

This revision, however, doesn’t take into account Black women, who die from cervical cancer at more than two times the rate of white women. Nor does it address the consequences from delays in screening; Black women are more likely to be diagnosed with advanced cervical cancer than any other racial group.

The ACS charged forward with these new recommendations despite the fact that we know the HPV test alone is less effective than co-testing with the Pap test.

Results from the largest cervical cancer screening study ever, released in July, found co-testing with the Pap test and HPV test identified more than 94 percent of cervical cancer cases and nearly 100 percent of pre-cancer cases in women who would be diagnosed within the next 12 months.

The revised guidelines also have been questioned by many gynecologists and organizations such as the Black Women’s Health Imperative, the American College of Obstetricians and Gynecologists and the Susan G. Komen Foundation.

“Cervical cancer is a preventable cancer, which we have the potential to eradicate through screening tests and then also with the HPV vaccine,” said Minnesota gynecologic oncologist Tri Dinh. 

We surmise the ACS went this direction because more than 90 percent of cervical cancer is caused by the human papillomavirus, to which an estimated 80 million people have been exposed.

The HPV test, which became available as a part of screening for cervical cancer in 1999, can determine if a woman has been exposed to the virus, compared to the Pap test, which has been around since the 1940s and identifies abnormal cells on the cervix.

“Both tests have value with respect to screening for cervical cancer, but strategies for preventing cervical cancer and guidelines may vary based on age, risk and other factors,” Dinh said. “It’s important to talk with your health care provider about options.”

Dr. Dinh also reminds that the HPV vaccine is a great preventive measure to cervical cancer. “The majority of people get exposed to HPV in their late teens or early 20s, so that is why early immunization such an important prevention measure,” he said. The vaccine is approved for both girls and boys, beginning at age 9.

An estimated 4,300 women will die in the United States from cervical cancer this year. Clarity drives trust and trust is essential to making progress in fighting this reproductive cancer. The new guidelines muddy the waters of understanding just enough to erode trust in the medical system, which is the last thing Black women need when it comes to their reproductive health.


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