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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Friday, January 13, 2006

    The Much Ado Department: A new study says that the modern pap smear is not all it's been touted to be:

    The recent advent of a purportedly more accurate, liquid-based Pap smear led the American Cancer Society to recommend that women go for the test once every two years, as opposed to the annual test recommended for the older version of the Pap smear.

    But Australian researchers are now calling that recommendation into question. Their study suggests that the newer cytology (cell-based) screen may be no more effective than the older version.

    "The evidence presented here does not lend support to a conclusion that liquid-based cytology is better than conventional cytology," the study authors wrote in the Jan. 14 issue of The Lancet.

    The problem with that assertion is that the new technology is not what led to the change in pap smear screening recommendations. It was the recognition that continuing to do yearly pap smears in women who have had a history of repeatedly normal pap smears doesn't improve the detection rate of cancer or significantly abnormal paps. Anyone who has ever had an abnormal pap smear is still supposed to get yearly pap smears. It's only the cervically pristine who are allowed to skip every other year.

    The liquid-based pap was also never touted as "better" at detecting cancer than the traditional smear. But it does result in a better sample that's easier for the pathologist/and or technician to read. The old way resulted in clumped cells that lay on top of each other. The new way spreads them out nicely on the slide with few overlaps.

    Also, the liquid-based pap can identify the DNA of human papilloma virus in the sample, something which could not be done with the old paps. This is important because women with papilloma virus are at a higher risk of developing cervical cancer. A mild abnormality on a pap smear in conjunction with the presence of human papilloma virus means that even the mild abnormality has to be taken seriously and investigated further. Before the advent of the liquid-based pap and the ability to test for HPV so easily, all the mild abnormalities got treated the same way. Even those whose abnormalities were due to innocous inflammation.

    As the many experts quoted in the article point out, this research will not change the way we do paps one iota. Nor should it.

    P.S. And just by coincidence, the British Medical Journal has an article on the cost effectiveness of HPV testing with the pap. It is cost-effective.

    posted by Sydney on 1/13/2006 09:33:00 PM 0 comments


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