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Thursday, April 25, 2002Cells can be slightly abnormal because of irritation, inflammation or infection. If the infection happens to be caused by the human papilloma virus (HPV) then those slightly abnormal cells have a higher risk of going on to become cancerous. We now have the technology to test for human papilloma virus infection with the same sample of cells that are used for the pap. It is this ability that has made the new guidelines possible. In the past, when a pap was mildly abnormal, the pathologist would make a judgement on whether or not it was likely to be a benign cause or to be a precursor to cancer. Now, he no longer has to make that difficult distinction. In addition, the same cell sample can now be tested for the presence of HPV, and that HPV can be further tested to see if it is the type of HPV that is associated with increased cancer risks or if it is the benign version that has no risk. If the HPV test is positive for the high risk type, then the patient warrants a closer look. If not, the patient can be screened routinely as if she had a normal pap. This will reduce significantly the number of women who have to undergo biopsies and repeat testing. As this quote from an American Cancer Society spokeswoman points out: "Right now, there's a lot of overdiagnosis, a lot of extra unneeded follow-up tests that are being done, which are a tremendous health care cost but also a tremendous cost to the women in terms of anxiety, time and discomfort," said the cancer society's Debbie Saslow. If many women with inconclusive results can be reassured, "that will be a big benefit for society." The new guidelines were adopted with no controversy at all, in contrast to attempts to modify the guidelines for screening mammography. The American Cancer Society still insists that mammograms save lives by detecting cancer early despite much evidence to the contrary. For some reason they have turned a deaf ear and a blind eye to the realities of breast cancer screening. The difference, of course, is that pap smears and cervical cancer have not been politicized as has breast cancer. No one wears pink ribbons on behalf of cervical cancer victims, Congress doesn’t hold hearings on pap smears, and pathologists and gynecologists don't try to bully guideline authors into accepting the validity of one approach, as radiology groups have done with mammograms. In fact, the published guidelines are careful to reveal the financial interests of one of the authors. (The disclosure is at the bottom of the abstract.) The approach to the pap smear guidelines should be used as a model for all medical guidelines. The data on effectiveness should be made by a panel of physicians who are not influenced by politics; senators and congressmen should stay out of the process completely; and all financial interests of those involved should be fully disclosed. posted by Sydney on 4/25/2002 08:27:00 AM 0 comments 0 Comments: |
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