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Old 09-18-2012, 10:52 AM   #1
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What is the science behind Pap Smear screening guidelines?

We know HPV has to be present for cervical dysplasia.

How does a monogamous women in a 15 year marriage who has tested neg-Pap for 20 years / neg HPV DNA for 5 and has had unprotected sex only with her husband, contract HPV?

How does it make sense to continue pap smears at all (nevermind 3 year recommendation or 5 year with HPV DNA)?

And where are the home HPV DNA kits since self-collection has the same false negative rates as clinical collection (looking at you FDA...)?

The elephant in the room seems to be the notion of a unreported infidelity by husband or a lie by wife. But that's insulting and is a risk best assessed and managed personally.

The PAP smear guidelines still seem ridiculous and the industry's attitude is akin to a state mandated inspection program (vs. a service provided to meet demand).

 
Old 09-18-2012, 04:20 PM   #2
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Re: What is the science behind Pap Smear screening guidelines?

The purpose of a pap smear is not, first and foremost, to detect HPV. That's a recent utilization of the test. The purpose is to test for any abnormal cells which can mean cancer - and it doesn't have to be caused by HPV. There are other causes.

 
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Old 10-03-2012, 06:05 AM   #3
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Re: What is the science behind Pap Smear screening guidelines?

Quote:
Originally Posted by CountMeAmused View Post
We know HPV has to be present for cervical dysplasia.

How does a monogamous women in a 15 year marriage who has tested neg-Pap for 20 years / neg HPV DNA for 5 and has had unprotected sex only with her husband, contract HPV?

How does it make sense to continue pap smears at all (nevermind 3 year recommendation or 5 year with HPV DNA)?

And where are the home HPV DNA kits since self-collection has the same false negative rates as clinical collection (looking at you FDA...)?

The elephant in the room seems to be the notion of a unreported infidelity by husband or a lie by wife. But that's insulting and is a risk best assessed and managed personally.

The PAP smear guidelines still seem ridiculous and the industry's attitude is akin to a state mandated inspection program (vs. a service provided to meet demand).
You are spot on, CMA, most programs are not evidence based...most women are having unnecessary pap testing and many face excess biopsies and potentially harmful over-treatment. Take a look at the new Dutch program to be implemented shortly...women will be offered 5 hrHPV primary triage tests at ages 30,35,40,50 and 60 and only the roughly 5% who are HPV positive and at risk will be offered a 5 yearly pap test. Most women are HPV negative, about 95% of women aged 30 and older, they can only be worried and harmed by pap testing. Under the new Dutch program the HPV negative women will be offered the HPV primary testing program or they can test themselves with the Delphi Screener. Those HPV negative and confidently monogamous or no longer sexually active can forget further testing.
Many countries will never see evidence based testing, IMO, population pap testing and the enormous over-treatment it generates means huge profits...excess suits many, but is a lousy deal for women. Population pap testing misses too many of these rare cancers, condemns huge numbers to excess biopsies, potentially harmful over-treatment and a lifetime of unnecessary pap testing and it wastes a fortune...it also shows a deep disrespect for the bodily privacy of women, as well as a cavalier disregard for our health and legal rights. I made an informed decision not to test decades ago...if I were concerned about this rare cancer, and I'm not, I wouldn't even consider a pap test before establishing I was HPV positive and at risk...there is no point pap testing and doing biopsies etc on HPV negative women...it certainly is not in the interests of women.
I can't mention other websites as it apparently breaches the rules here, but if you search unnecessary pap smears, you'll find forums with many posts from women concerned about the misinformation and complete absence of informed consent in women's cancer screening and many tragic posts from women harmed by this testing.

Last edited by Eliz52; 10-03-2012 at 06:15 AM.

 
Old 10-03-2012, 06:20 AM   #4
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Re: What is the science behind Pap Smear screening guidelines?

Quote:
Originally Posted by Titchou View Post
The purpose of a pap smear is not, first and foremost, to detect HPV. That's a recent utilization of the test. The purpose is to test for any abnormal cells which can mean cancer - and it doesn't have to be caused by HPV. There are other causes.
If you're HPV negative you can't be helped by pap testing, you're not at risk and if you're HPV positive and aged 30+ you have a small chance of benefiting from a five yearly pap test, at least until you test negative for the virus (when cleared by your immune system) the new Dutch program will only offer pap testing to the roughly 5% of women aged 30 and older who are HPV positive and at risk and apart from the invasive HPV primary test, there are also self test options available.

 
Old 10-03-2012, 05:51 PM   #5
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Re: What is the science behind Pap Smear screening guidelines?

From statistics I have read, about 70% of cervical cancer world wide is caused by HPV. The remaining 30% is caused by other things. I think it behooves one to determine which group you may be in.

 
Old 10-03-2012, 08:18 PM   #6
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Re: What is the science behind Pap Smear screening guidelines?

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Originally Posted by Titchou View Post
From statistics I have read, about 70% of cervical cancer world wide is caused by HPV. The remaining 30% is caused by other things. I think it behooves one to determine which group you may be in.
It's now quite clear cervical cancer is linked with HPV...it's the starting point, so if you're HPV negative you have nothing to fear from cervical cancer. The evidence is so clear Dutch women who are HPV negative and that's about 95% of those aged 30 and older will not be offered pap testing under their new program. Other countries like Finland are also now looking at HPV primary testing and of course, self-testing is possible and reliable and being used in several countries. (Singapore, Italy, Malaysia, UK and others)
Of course, being HPV+ does not mean you'll get cervical cancer, most women will clear the virus within a year or two, but it's this small percentage of women who are at risk and may benefit from a 5 yearly pap test until they clear the virus. HPV negative women cannot benefit from pap testing, they just accept risk...that's why women should pressure the govt and profession for access to HPV PRIMARY testing and self-testing options...population pap testing is great for profits, but a lousy deal for women. Using pap testing AND HPV testing on all women (currently being done in the States) is excessive, unhelpful and unnecessary and just leads to lots of potentially harmful over-treatment and over-investigation.
You'll find real information in countries like the Netherlands and Finland that practice evidence based medicine, unfortunately, women's cancer screening in many countries, including Australia and the States, is heavily influenced by vested ($$$) and political interests and often well-meaning, but misguided, pressure and gender groups who think more is better, it's not...it's harmful.

Last edited by Eliz52; 10-03-2012 at 08:19 PM.

 
Old 10-04-2012, 05:17 PM   #7
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Re: What is the science behind Pap Smear screening guidelines?

Frankly I don't see any untoward risks in having a Pap smear annually. I've had 3 or 4abnormal paps over the years and was not pressured to any treatment plan other than to come back in 6 months for another. I did and nothing showed up the second time. One time I am sure the abnormal result was from having sex the night before as I forgot about the gyno appt the next day. I do agree that women aren't told reasons a pap could be abnormal from such things as sex in the recent past and even so much as bubble bath the night before so that they can avoid them and have valid test results. But it behooves us all to ask more questions and demand more answers and alternatives.
We need to be participants in our healthcare - not bystanders.

None of this however, changes the fact that some cases of cervical cancer are not caused by the woman being HPV positive. To say they all are is to put women who have not been exposed to HPV and have cervical cancer in an untenable situation with their loved ones. And then there are those cases where HPV was transmitted by the mother to the child during birth. And that's a whole other story.

 
Old 10-04-2012, 06:04 PM   #8
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Re: What is the science behind Pap Smear screening guidelines?

Quote:
Originally Posted by Titchou View Post
Frankly I don't see any untoward risks in having a Pap smear annually. I've had 3 or 4abnormal paps over the years and was not pressured to any treatment plan other than to come back in 6 months for another. I did and nothing showed up the second time. One time I am sure the abnormal result was from having sex the night before as I forgot about the gyno appt the next day. I do agree that women aren't told reasons a pap could be abnormal from such things as sex in the recent past and even so much as bubble bath the night before so that they can avoid them and have valid test results. But it behooves us all to ask more questions and demand more answers and alternatives.
We need to be participants in our healthcare - not bystanders.

None of this however, changes the fact that some cases of cervical cancer are not caused by the woman being HPV positive. To say they all are is to put women who have not been exposed to HPV and have cervical cancer in an untenable situation with their loved ones. And then there are those cases where HPV was transmitted by the mother to the child during birth. And that's a whole other story.
Even when a child is infected by the mother, that doesn't change a thing, HPV primary testing provides you with very important information, I'm at risk or not at risk, HPV positive or negative.
If you want to have unnecessary pap tests every year and don't mind dealing with false positives and the risk of potentially harmful over-treatment, that's your business, but women should be provided with honest information so they understand what they're agreeing to...the benefit with annual and 5 yearly pap tests is the same, but the more often you screen, the more false positives you produce, not surprised you've had a few already....the referral rate for colposcopy/biopsy with annual pap testing is very high, Dr Richard DeMay, the American pathologist, put it as high as 95% lifetime risk, and it would certainly be higher than the Australian referral rate of 77%... now this is for a cancer with a 0.65% lifetime risk.
Frankly though, any doctor promoting annual testing is IMO, either incompetent or unethical, he/she is taking a huge risk with the health of their patient for no additional benefit. You may not mind false positives, but many women find them terribly distressing, not to mention the huge number that end up being over-treated and having excess biopsies..some of whom end up with damage to the cervix and can then have issues - premature babies, miscarriages, infertility, the need for c-sections, cervical cerclage etc
Population pap testing is now outdated anyway, why would a HPV negative woman, most of us, want to spend a lifetime having unnecessary pap testing and the risk of over-treatment?
You may be accepting of annual pap testing because you're also having routine pelvic and breast exams, if so, you might want to consider the evidence there, neither is recommended in Australia, the UK and in many other countries. The routine pelvic exam is of poor clinical value and carries risk...your Dr Carolyn Westhoff partly blames this exam for your high hysterectomy rates, 1 in 3 will have one by age 60, and women losing healthy ovaries after false positive exams...routine breast exams don't bring down the death rate, but lead to excess biopsies.
The evidence is clear now that HPV negative women have nothing to fear from cc and that's why countries that do what's best for women adopt evidence based programs. Sadly, women's healthcare in the States (and to a lesser degree, Australia) is IMO, about harmful excess and huge profits for the medical profession. The Finns have the lowest rates of cc in the world and refer far fewer women, yet have had a 6-7 pap test program, 5 yearly from 30 to 60, since the 1960s...some older American women have had 40 pap tests, just absurd...and yet the States has more cc than Finland...excess just worries and harms women and makes billions for the medical profession.
Anyway, good luck to you, you'll need it with your annual pap testing, please be careful...it horrifies me to hear that some women are still having annual pap testing, these doctors really should be stopped, they know their patients cannot benefit from this excess and can only be worried and harmed.
Unfortunately, this forum does not permit links or references to other websites or I could post some references for you. Sadly, I believe many women have been misinformed over decades and are now afraid to move away from excess.
I've done a lot of reading on this subject over many years and I don't think a HPV negative women is at risk of cc...of course, she can get a new infection, but that's why women will be offered 5 hrHPV primary tests at 30,35,40,50 and 60 to cover that possibility, or they can test themselves, but women HPV negative and no longer sexually active may choose to stop all further testing and women who are confidently monogamous may do the same...up to them.
It's time women were included in the decision-making and that's only possible with access to real information. I had to do my own research, that shouldn't be necessary. Anyway, nice chatting to you.

 
Old 10-04-2012, 10:26 PM   #9
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Re: What is the science behind Pap Smear screening guidelines?

Quote:
Originally Posted by Titchou View Post
From statistics I have read, about 70% of cervical cancer world wide is caused by HPV. The remaining 30% is caused by other things. I think it behooves one to determine which group you may be in.
I just checked a medical website and this is where you're getting the 70% figure:
"Virtually all cervical cancers are caused by HPV infections, with just two HPV types, 16 and 18, responsible for about 70 percent of all cases (5, 6). HPV also causes anal cancer, with about 85 percent of all cases caused by HPV-16. HPV types 16 and 18 have also been found to cause close to half of vaginal, vulvar, and penile cancers (7).
Most recently, HPV infections have been found to cause cancer of the oropharynx, which is the middle part of the throat including the soft palate, the base of the tongue, and the tonsils. In the United States, more than half of the cancers diagnosed in the oropharynx are linked to HPV-16 (8)"

So 2 high risk strains of HPV (16 and 18) account for 70% of cervical cancer cases and the rest are caused by other strains of HPV.
Thus HPV negative and not at risk and that's why these women will not be offered pap tests under the new Dutch program. Hope this helps..

 
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