For Cervical Cancer Screening, Women Over 30 Can Now Choose HPV Test Only
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The influential group, the U.S. Preventive Services Task Force, has expanded its recommendations for this potentially lifesaving exam.\u003c/p>\n\u003cp>The new recommendations \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.10897\" target=\"_blank\" rel=\"noopener\">are published\u003c/a> in the latest issue of \u003cem>JAMA.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022605/\" target=\"_blank\" rel=\"noopener\">Pap smears\u003c/a> have saved many lives since they became available decades ago. Inspecting samples of cervical tissue for precancerous changes is effective at catching possible cancer and is still the go-to test for women ages 21 to 29, according to the USPSTF guidelines.\u003c/p>\n\u003cp>But there's another option. \"Most cervical cancer is caused by what's called the human papillomavirus, or HPV,\" says \u003ca href=\"https://profiles.stanford.edu/douglas-owens\" target=\"_blank\" rel=\"noopener\">Dr. Douglas Owens\u003c/a>, a professor of medicine at Stanford University and vice chair of the USPSTF. \"And we now have tests for HPV and that's an important step forward.\"\u003c/p>\n\u003cp>These tests are available alone or in combination with the Pap test. And the USPSTF now says \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/03/625696664/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear\" target=\"_blank\" rel=\"noopener\">the evidence\u003c/a> is strong enough that HPV tests can be used by themselves, for women over 30. That third choice expands on the task force's previous recommendation, which was for the Pap test or the combination test.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And while Pap tests should be repeated every three years, women can wait five years between HPV tests.\u003c/p>\n\u003cp>\"Five years is a good balance between the benefits and harms,\" Owens says. \"It's still highly effective at detecting cancer, and screening more frequently than that may increase some of the potential harms, so we think that's a good interval.\"\u003c/p>\n\u003cp>Potential harms of too frequent screening include unnecessary follow-ups such as biopsies. In a draft recommendation released last year, the task force had considered suggesting just two options, either the Pap smear or the HPV test, but its final recommendation included the hybrid test too.\u003c/p>\n\u003cp>\"The HPV test alone is not available everywhere,\" Owens explains. \"And so we want to be sure that women no matter where they're receiving care have options for cervical cancer screening.\"\u003c/p>\n\u003cp>He says the combination test is widely available, as is the Pap test, \"so all of those are good options and a woman can discuss with her physician what's available at the place where she's receiving care.\"\u003c/p>\n\u003cp>Women may not notice the difference between tests because tissue samples are all collected the same way. But \u003ca href=\"http://pressroom.cancer.org/debbiesaslow\" target=\"_blank\" rel=\"noopener\">Debbie Saslow\u003c/a>, senior director for HPV-related and women's cancers at the American Cancer Society, says if women have a choice, she would recommend the HPV test for women over 30.\u003c/p>\n\u003cp>\"I truly believe that including the HPV test, either along with the Pap or instead of the Pap, is superior than the Pap alone,\" she says. There's some evidence the HPV test is better than the Pap test at detecting a less common form of cervical cancer, adenocarcinoma, she says. \"So wouldn't you rather find the two most common cancers instead of just the one most common type?\"\u003c/p>\n\u003cp>The task force emphasizes that all three tests are highly effective. The overarching recommendation is simply that women should get screened, and to do so regularly until the age of 65. If screening has been adequate up to that point, the task force says women do not need further cervical cancer screening.\u003c/p>\n\u003cp>Health officials also recommend the HPV vaccine, which is given to girls and young women, up to age 26. (Boys and young men are encouraged to get the HPV vaccine as well.) But Owens says a vaccine alone doesn't replace cervical cancer screening.\u003c/p>\n\u003cp>\"Our recommendation applies to everyone whether you've been vaccinated or not,\" he says. \"It's very important that women do not forgo screening because they've been vaccinated.\"\u003c/p>\n\u003cp>An effective vaccine could ultimately render cervical cancer screening unnecessary, but that change will require careful study and could be years away.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>You can reach Richard Harris at \u003c/em>\u003ca href=\"mailto:rharris@npr.org\" target=\"_blank\" rel=\"noopener\">rharris@npr.org\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=For+Cervical+Cancer+Screening%2C+Women+Over+30+Can+Now+Choose+The+HPV+Test+Only&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"HPV testing is now seen as equally effective as Pap tests for cervical cancer screening. An influential federal advisory group has changed guidelines for how women over 30 should get tested. ","status":"publish","parent":0,"modified":1534966663,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":665},"headData":{"title":"For Cervical Cancer Screening, Women Over 30 Can Now Choose HPV Test Only | KQED","description":"HPV testing is now seen as equally effective as Pap tests for cervical cancer screening. An influential federal advisory group has changed guidelines for how women over 30 should get tested. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"444026 https://ww2.kqed.org/futureofyou/?p=444026","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/08/22/for-cervical-cancer-screening-women-over-30-can-now-choose-hpv-test-only/","disqusTitle":"For Cervical Cancer Screening, Women Over 30 Can Now Choose HPV Test Only","source":"Health","nprImageCredit":"Science Photo Library","nprByline":"Richard Harris, NPR","nprImageAgency":"Getty Images","nprStoryId":"640514865","nprApiLink":"http://api.npr.org/query?id=640514865&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/08/21/640514865/for-cervical-cancer-screening-women-over-30-can-now-choose-the-hpv-test-only?ft=nprml&f=640514865","nprRetrievedStory":"1","nprPubDate":"Tue, 21 Aug 2018 21:50:00 -0400","nprStoryDate":"Tue, 21 Aug 2018 11:03:00 -0400","nprLastModifiedDate":"Tue, 21 Aug 2018 17:17:42 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/08/20180821_atc_for_cervical_cancer_screening_women_over_30_can_now_choose_the_hpv_test_only.mp3?orgId=1&topicId=1128&d=234&p=2&story=640514865&ft=nprml&f=640514865","nprAudioM3u":"http://api.npr.org/m3u/1640630633-193947.m3u?orgId=1&topicId=1128&d=234&p=2&story=640514865&ft=nprml&f=640514865","audioTrackLength":235,"path":"/futureofyou/444026/for-cervical-cancer-screening-women-over-30-can-now-choose-hpv-test-only","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2018/08/20180821_atc_for_cervical_cancer_screening_women_over_30_can_now_choose_the_hpv_test_only.mp3?orgId=1&topicId=1128&d=234&p=2&story=640514865&ft=nprml&f=640514865","parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal health advisers say women can now consider three options when it's time for their cervical cancer screening tests. The influential group, the U.S. Preventive Services Task Force, has expanded its recommendations for this potentially lifesaving exam.\u003c/p>\n\u003cp>The new recommendations \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.10897\" target=\"_blank\" rel=\"noopener\">are published\u003c/a> in the latest issue of \u003cem>JAMA.\u003c/em>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022605/\" target=\"_blank\" rel=\"noopener\">Pap smears\u003c/a> have saved many lives since they became available decades ago. Inspecting samples of cervical tissue for precancerous changes is effective at catching possible cancer and is still the go-to test for women ages 21 to 29, according to the USPSTF guidelines.\u003c/p>\n\u003cp>But there's another option. \"Most cervical cancer is caused by what's called the human papillomavirus, or HPV,\" says \u003ca href=\"https://profiles.stanford.edu/douglas-owens\" target=\"_blank\" rel=\"noopener\">Dr. Douglas Owens\u003c/a>, a professor of medicine at Stanford University and vice chair of the USPSTF. \"And we now have tests for HPV and that's an important step forward.\"\u003c/p>\n\u003cp>These tests are available alone or in combination with the Pap test. And the USPSTF now says \u003ca href=\"https://www.npr.org/sections/health-shots/2018/07/03/625696664/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear\" target=\"_blank\" rel=\"noopener\">the evidence\u003c/a> is strong enough that HPV tests can be used by themselves, for women over 30. That third choice expands on the task force's previous recommendation, which was for the Pap test or the combination test.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And while Pap tests should be repeated every three years, women can wait five years between HPV tests.\u003c/p>\n\u003cp>\"Five years is a good balance between the benefits and harms,\" Owens says. \"It's still highly effective at detecting cancer, and screening more frequently than that may increase some of the potential harms, so we think that's a good interval.\"\u003c/p>\n\u003cp>Potential harms of too frequent screening include unnecessary follow-ups such as biopsies. In a draft recommendation released last year, the task force had considered suggesting just two options, either the Pap smear or the HPV test, but its final recommendation included the hybrid test too.\u003c/p>\n\u003cp>\"The HPV test alone is not available everywhere,\" Owens explains. \"And so we want to be sure that women no matter where they're receiving care have options for cervical cancer screening.\"\u003c/p>\n\u003cp>He says the combination test is widely available, as is the Pap test, \"so all of those are good options and a woman can discuss with her physician what's available at the place where she's receiving care.\"\u003c/p>\n\u003cp>Women may not notice the difference between tests because tissue samples are all collected the same way. But \u003ca href=\"http://pressroom.cancer.org/debbiesaslow\" target=\"_blank\" rel=\"noopener\">Debbie Saslow\u003c/a>, senior director for HPV-related and women's cancers at the American Cancer Society, says if women have a choice, she would recommend the HPV test for women over 30.\u003c/p>\n\u003cp>\"I truly believe that including the HPV test, either along with the Pap or instead of the Pap, is superior than the Pap alone,\" she says. There's some evidence the HPV test is better than the Pap test at detecting a less common form of cervical cancer, adenocarcinoma, she says. \"So wouldn't you rather find the two most common cancers instead of just the one most common type?\"\u003c/p>\n\u003cp>The task force emphasizes that all three tests are highly effective. The overarching recommendation is simply that women should get screened, and to do so regularly until the age of 65. If screening has been adequate up to that point, the task force says women do not need further cervical cancer screening.\u003c/p>\n\u003cp>Health officials also recommend the HPV vaccine, which is given to girls and young women, up to age 26. (Boys and young men are encouraged to get the HPV vaccine as well.) But Owens says a vaccine alone doesn't replace cervical cancer screening.\u003c/p>\n\u003cp>\"Our recommendation applies to everyone whether you've been vaccinated or not,\" he says. \"It's very important that women do not forgo screening because they've been vaccinated.\"\u003c/p>\n\u003cp>An effective vaccine could ultimately render cervical cancer screening unnecessary, but that change will require careful study and could be years away.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>You can reach Richard Harris at \u003c/em>\u003ca href=\"mailto:rharris@npr.org\" target=\"_blank\" rel=\"noopener\">rharris@npr.org\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=For+Cervical+Cancer+Screening%2C+Women+Over+30+Can+Now+Choose+The+HPV+Test+Only&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444026/for-cervical-cancer-screening-women-over-30-can-now-choose-hpv-test-only","authors":["byline_futureofyou_444026"],"series":["futureofyou_219"],"categories":["futureofyou_1060","futureofyou_1","futureofyou_73"],"tags":["futureofyou_213","futureofyou_1597","futureofyou_218","futureofyou_275"],"collections":["futureofyou_1093"],"featImg":"futureofyou_444027","label":"source_futureofyou_444026"},"futureofyou_1819":{"type":"posts","id":"futureofyou_1819","meta":{"index":"posts_1591205157","site":"futureofyou","id":"1819","score":null,"sort":[1430156452000]},"guestAuthors":[],"slug":"smartphones-vinegar-and-the-future-of-cervical-cancer-screening","title":"Smartphones, Vinegar and the Future of Cervical Cancer Screening","publishDate":1430156452,"format":"standard","headTitle":"Women’s Health | Future of You | KQED Future of You | KQED Science","labelTerm":{"term":54,"site":"futureofyou"},"content":"\u003cp>100 years ago, cervical cancer reigned as the leading cause of cancer death for women in the United States\u003c/p>\n\u003cp>Then,\u003ca href=\"http://weill.cornell.edu/archives/blog/2011/06/george-papanicolaou-development-of-the-pap-smear.html\">\u003cspan style=\"color: #1155cc\"> a doctor at Cornell University\u003c/span>\u003c/a> began conducting studies on the sex cycle of guinea pigs and in 1915 realized that a similar “smear” technique could be applied to the study of human vaginal cells. A few decades of disinterest and skepticism later, the Pap smear became the standard cancer screening test for women. Today, \u003ca href=\"http://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=76\">\u003cspan style=\"color: #1155cc\">the cervical cancer death rate has plunged by more than 50 percent and ranks 14th in frequency in the United States.\u003c/span>\u003c/a>\u003c/p>\n\u003cp>This is far from the case in developing countries, where \u003ca href=\"http://www.womendeliver.org/assets/CervicalCancer_final.pdf\">\u003cspan style=\"color: #1155cc\">cervical cancer is the most common cancer\u003c/span>\u003c/a> and the leading cause of cancer deaths among women. \u003ca href=\"http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/cervical-cancer-statistics\">\u003cspan style=\"color: #1155cc\">Over 85 percent of cervical cancer cases occur\u003c/span>\u003c/a> in the developing world and these staggering rates are largely due to the lack of screening. Pap smears are rare and less than five percent of women receive any cervical cancer screening at all.\u003c/p>\n\u003cp>However, new research and innovations in cervical cancer screening are helping to increase its breadth and frequency in many of the world’s poorest countries. Moreover, these new approaches are actually more accurate, convenient, and cost-effective than the traditional Pap smear, not to mention less unpleasant. They let doctors and their patients bypass the Pap smear altogether, while the Pap smear’s dominance in the U.S. remains strong.\u003c/p>\n\u003cp>\u003cstrong>No Place for the Pap\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Many women may be surprised to learn that the Pap smear only detects cancer about half of the time but repeating the test on a regular basis increases the chances of finding cancer since the disease is slow to develop.\u003c/p>\n\u003cp>Repeating the test regularly is often not an option in developing countries where a number of barriers -- time, money, distance, transportation, children, agricultural cycles, social stigmas -- prevent women from visiting health clinics. Paps also take a hefty amount of resources to administer and read.\u003c/p>\n\u003cp>“The Pap test is hard to implement in low resource settings because it requires expensive machines, labs, and trained technicians, as well as for women to make the trips to clinics,” said Dr. José Jerónimo, the senior adviser for women’s cancers in a reproductive health program called \u003ca href=\"http://www.path.org/our-work/reproductive-health.php\">PATH\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"http://www.path.org/\">PATH\u003c/a> is an international nonprofit dedicated to accelerating health innovation in the developing world. The organization has a number of initiatives aimed at making cervical cancer screening and prevention more prevalent in under-resourced areas. A key part of its approach is a low-tech effort called “VIA”, which stands for visual inspection with acetic acid.\u003c/p>\n\u003cfigure id=\"attachment_2125\" class=\"wp-caption aligncenter\" style=\"max-width: 446px\">\u003cimg class=\" wp-image-2125\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/Unknown-4-800x450.jpeg\" alt=\"Many new technologies are deployed first in developing countries \" width=\"446\" height=\"251\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-800x450.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-400x225.jpeg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-1180x664.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-768x432.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-320x180.jpeg 320w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4.jpeg 1920w\" sizes=\"(max-width: 446px) 100vw, 446px\">\u003cfigcaption class=\"wp-caption-text\">Many new technologies are deployed first in developing countries \u003ccite>(TeamLiveLonger )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This method involves swabbing the cervix with a 3 to 5 percent vinegar solution during a speculum exam, waiting for one minute, and then observing the cervix to see if white areas appear. In addition to being inexpensive and easy to administer, VIA also provides immediate results. It allows a patient to immediately receive guidance on next steps if the test is positive.\u003c/p>\n\u003cp>However, like the Pap, the vinegar technique only identifies 50 to 60 percent of precancerous cases, which is why PATH helped develop \u003ca href=\"http://www.path.org/news/press-room/147/\">a new molecular test called careHPV\u003c/a> that was developed and field tested for use in low-resource settings.\u003c/p>\n\u003cp>CareHPV can detect DNA from 14 cancer-causing types of HPV in 2.5 hours without extensive lab facilities, using an affordable machine the size of a toaster oven that runs on electricity or a battery. Women can collect their own samples using a small brush, without the need for a pelvic exam.\u003c/p>\n\u003cp>This approach is ideal for environments where health care resources are limited and testing is often administered by community health workers who visit people’s homes, as well as in places where stigmas against pelvic exams persist.\u003c/p>\n\u003cp>Dr. Jerónimo said that simply by allowing women to collect the sample themselves, coverage increases by 4 times.\u003c/p>\n\u003cfigure id=\"attachment_2124\" class=\"wp-caption aligncenter\" style=\"max-width: 443px\">\u003cimg class=\"wp-image-2124\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/Unknown-2-800x533.jpeg\" alt=\"A group of medical students learn how to send images \" width=\"443\" height=\"295\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-800x533.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-400x266.jpeg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-1180x786.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-768x511.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-320x213.jpeg 320w\" sizes=\"(max-width: 443px) 100vw, 443px\">\u003cfigcaption class=\"wp-caption-text\">A group of medical students learn how to send images \u003ccite>(TeamLiveLonger )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Texting, Calling, and Cervical Cancer Screening\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.mobileodt.com/\">MobileODT\u003c/a> is a startup that makes a mobile colposcope, a long-range, Internet-connected magnifying glass that plugs into smartphones. The device provides a high-resolution image of cervical tissue, which can then be securely transmitted for diagnostics.\u003c/p>\n\u003cp>[Skip to the bottom to a video of how a mobile colposcope works.]\u003c/p>\n\u003cp>“There are very few labs or specialists in developing countries who are able to correctly assess cervical cancer at its early stages,” said MobileODT chief executive and cofounder Ariel Beery.\u003c/p>\n\u003cp>“What we seek to do is enable those same health workers who are already in the field to use a tool they use everyday — a mobile phone — to better visualize the cervix and collaborate with experts to process those images with greater accuracy.”\u003c/p>\n\u003cp>The advanced prototype of the mobile colposcope is currently being piloted in Kenya, Haiti, Mexico, Botswana and the U.S.. The startup ultimately hopes to use the data it collects to develop algorithms that are able to assess the risk of cervical cancer at any stage of the viruses’ development.\u003c/p>\n\u003cp>\u003ca href=\"https://www.indiegogo.com/projects/teamlivelonger-battling-cervical-cancer-in-haiti\">TeamLiveLonger\u003c/a> is another startup leveraging smartphone technology to combat cervical cancer, although its goal is to increase the feasibility of Pap smears, rather than replace them.\u003c/p>\n\u003cp>Founder Lou Auguste is of Haitian descent and worked as a first responder after the 2010 earthquake. There, he learned that Haitian women have the highest rate of mortality from cervical cancer in the world, with 54 per 100,000 women dying from the disease each year.\u003c/p>\n\u003cp>“Most women in Haiti have never been tested for cervical cancer or they don’t catch it before it is too late,” Auguste said.\u003c/p>\n\u003cp>“Doctors know how to perform pap smears but we realized there were only 5 pathologists in the whole country, so we needed to figure out a system for sending slides for consultations abroad.”\u003c/p>\n\u003cp>TeamLiveLonger developed an adaptor that connects a smartphone to a microscope to acquire images of slides. Its mobile technology then stitches the images together to produce a whole slide and securely transfers the images via a service called BitTorrent Sync (which enables the app to transfer large files over bad Internet connections) to a pathologist in the U.S. for analysis and diagnosis. TeamLiveLonger also built an electronic health record for mobile devices that makes it easy for health workers to keep cases updated and know when people come back to the clinic to receive results or treatment.\u003c/p>\n\u003cp>The Pap smear may not be the best method of screening for cervical cancer but it does hold the dubious distinction of being the most prevalent one. Innovation after innovation has emerged in this space over the past 20 years but their adoption is much faster in the developing world without the entrenched legacy of the Pap smear to overcome.\u003c/p>\n\u003cp>While women in Haiti, India, Nicaragua and Uganda get screened for cervical cancer with a brush and a mobile phone, it looks like women in the U.S. will have to endure the speculum for the foreseeable future.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[youtube http://www.youtube.com/watch?v=Mm5ogJT-M9k]\u003c/p>\n\n","blocks":[],"excerpt":"Already dreading your next Pap smear? New medical screening tools offer a more affordable, less invasive alternative and women in the developing world are among the first to try them.","status":"publish","parent":0,"modified":1430164393,"stats":{"hasAudio":false,"hasVideo":true,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":30,"wordCount":1207},"headData":{"title":"Smartphones, Vinegar and the Future of Cervical Cancer Screening | KQED","description":"Already dreading your next Pap smear? New medical screening tools offer a more affordable, less invasive alternative and women in the developing world are among the first to try them.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"1819 http://ww2.kqed.org/futureofyou/?p=1819","disqusUrl":"https://ww2.kqed.org/futureofyou/2015/04/27/smartphones-vinegar-and-the-future-of-cervical-cancer-screening/","disqusTitle":"Smartphones, Vinegar and the Future of Cervical Cancer Screening","path":"/futureofyou/1819/smartphones-vinegar-and-the-future-of-cervical-cancer-screening","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>100 years ago, cervical cancer reigned as the leading cause of cancer death for women in the United States\u003c/p>\n\u003cp>Then,\u003ca href=\"http://weill.cornell.edu/archives/blog/2011/06/george-papanicolaou-development-of-the-pap-smear.html\">\u003cspan style=\"color: #1155cc\"> a doctor at Cornell University\u003c/span>\u003c/a> began conducting studies on the sex cycle of guinea pigs and in 1915 realized that a similar “smear” technique could be applied to the study of human vaginal cells. A few decades of disinterest and skepticism later, the Pap smear became the standard cancer screening test for women. Today, \u003ca href=\"http://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=76\">\u003cspan style=\"color: #1155cc\">the cervical cancer death rate has plunged by more than 50 percent and ranks 14th in frequency in the United States.\u003c/span>\u003c/a>\u003c/p>\n\u003cp>This is far from the case in developing countries, where \u003ca href=\"http://www.womendeliver.org/assets/CervicalCancer_final.pdf\">\u003cspan style=\"color: #1155cc\">cervical cancer is the most common cancer\u003c/span>\u003c/a> and the leading cause of cancer deaths among women. \u003ca href=\"http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/cervical-cancer-statistics\">\u003cspan style=\"color: #1155cc\">Over 85 percent of cervical cancer cases occur\u003c/span>\u003c/a> in the developing world and these staggering rates are largely due to the lack of screening. Pap smears are rare and less than five percent of women receive any cervical cancer screening at all.\u003c/p>\n\u003cp>However, new research and innovations in cervical cancer screening are helping to increase its breadth and frequency in many of the world’s poorest countries. Moreover, these new approaches are actually more accurate, convenient, and cost-effective than the traditional Pap smear, not to mention less unpleasant. They let doctors and their patients bypass the Pap smear altogether, while the Pap smear’s dominance in the U.S. remains strong.\u003c/p>\n\u003cp>\u003cstrong>No Place for the Pap\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Many women may be surprised to learn that the Pap smear only detects cancer about half of the time but repeating the test on a regular basis increases the chances of finding cancer since the disease is slow to develop.\u003c/p>\n\u003cp>Repeating the test regularly is often not an option in developing countries where a number of barriers -- time, money, distance, transportation, children, agricultural cycles, social stigmas -- prevent women from visiting health clinics. Paps also take a hefty amount of resources to administer and read.\u003c/p>\n\u003cp>“The Pap test is hard to implement in low resource settings because it requires expensive machines, labs, and trained technicians, as well as for women to make the trips to clinics,” said Dr. José Jerónimo, the senior adviser for women’s cancers in a reproductive health program called \u003ca href=\"http://www.path.org/our-work/reproductive-health.php\">PATH\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"http://www.path.org/\">PATH\u003c/a> is an international nonprofit dedicated to accelerating health innovation in the developing world. The organization has a number of initiatives aimed at making cervical cancer screening and prevention more prevalent in under-resourced areas. A key part of its approach is a low-tech effort called “VIA”, which stands for visual inspection with acetic acid.\u003c/p>\n\u003cfigure id=\"attachment_2125\" class=\"wp-caption aligncenter\" style=\"max-width: 446px\">\u003cimg class=\" wp-image-2125\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/Unknown-4-800x450.jpeg\" alt=\"Many new technologies are deployed first in developing countries \" width=\"446\" height=\"251\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-800x450.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-400x225.jpeg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-1180x664.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-768x432.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4-320x180.jpeg 320w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-4.jpeg 1920w\" sizes=\"(max-width: 446px) 100vw, 446px\">\u003cfigcaption class=\"wp-caption-text\">Many new technologies are deployed first in developing countries \u003ccite>(TeamLiveLonger )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This method involves swabbing the cervix with a 3 to 5 percent vinegar solution during a speculum exam, waiting for one minute, and then observing the cervix to see if white areas appear. In addition to being inexpensive and easy to administer, VIA also provides immediate results. It allows a patient to immediately receive guidance on next steps if the test is positive.\u003c/p>\n\u003cp>However, like the Pap, the vinegar technique only identifies 50 to 60 percent of precancerous cases, which is why PATH helped develop \u003ca href=\"http://www.path.org/news/press-room/147/\">a new molecular test called careHPV\u003c/a> that was developed and field tested for use in low-resource settings.\u003c/p>\n\u003cp>CareHPV can detect DNA from 14 cancer-causing types of HPV in 2.5 hours without extensive lab facilities, using an affordable machine the size of a toaster oven that runs on electricity or a battery. Women can collect their own samples using a small brush, without the need for a pelvic exam.\u003c/p>\n\u003cp>This approach is ideal for environments where health care resources are limited and testing is often administered by community health workers who visit people’s homes, as well as in places where stigmas against pelvic exams persist.\u003c/p>\n\u003cp>Dr. Jerónimo said that simply by allowing women to collect the sample themselves, coverage increases by 4 times.\u003c/p>\n\u003cfigure id=\"attachment_2124\" class=\"wp-caption aligncenter\" style=\"max-width: 443px\">\u003cimg class=\"wp-image-2124\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2015/04/Unknown-2-800x533.jpeg\" alt=\"A group of medical students learn how to send images \" width=\"443\" height=\"295\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-800x533.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-400x266.jpeg 400w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-1180x786.jpeg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-768x511.jpeg 768w, https://ww2.kqed.org/app/uploads/sites/13/2015/04/Unknown-2-320x213.jpeg 320w\" sizes=\"(max-width: 443px) 100vw, 443px\">\u003cfigcaption class=\"wp-caption-text\">A group of medical students learn how to send images \u003ccite>(TeamLiveLonger )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Texting, Calling, and Cervical Cancer Screening\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.mobileodt.com/\">MobileODT\u003c/a> is a startup that makes a mobile colposcope, a long-range, Internet-connected magnifying glass that plugs into smartphones. The device provides a high-resolution image of cervical tissue, which can then be securely transmitted for diagnostics.\u003c/p>\n\u003cp>[Skip to the bottom to a video of how a mobile colposcope works.]\u003c/p>\n\u003cp>“There are very few labs or specialists in developing countries who are able to correctly assess cervical cancer at its early stages,” said MobileODT chief executive and cofounder Ariel Beery.\u003c/p>\n\u003cp>“What we seek to do is enable those same health workers who are already in the field to use a tool they use everyday — a mobile phone — to better visualize the cervix and collaborate with experts to process those images with greater accuracy.”\u003c/p>\n\u003cp>The advanced prototype of the mobile colposcope is currently being piloted in Kenya, Haiti, Mexico, Botswana and the U.S.. The startup ultimately hopes to use the data it collects to develop algorithms that are able to assess the risk of cervical cancer at any stage of the viruses’ development.\u003c/p>\n\u003cp>\u003ca href=\"https://www.indiegogo.com/projects/teamlivelonger-battling-cervical-cancer-in-haiti\">TeamLiveLonger\u003c/a> is another startup leveraging smartphone technology to combat cervical cancer, although its goal is to increase the feasibility of Pap smears, rather than replace them.\u003c/p>\n\u003cp>Founder Lou Auguste is of Haitian descent and worked as a first responder after the 2010 earthquake. There, he learned that Haitian women have the highest rate of mortality from cervical cancer in the world, with 54 per 100,000 women dying from the disease each year.\u003c/p>\n\u003cp>“Most women in Haiti have never been tested for cervical cancer or they don’t catch it before it is too late,” Auguste said.\u003c/p>\n\u003cp>“Doctors know how to perform pap smears but we realized there were only 5 pathologists in the whole country, so we needed to figure out a system for sending slides for consultations abroad.”\u003c/p>\n\u003cp>TeamLiveLonger developed an adaptor that connects a smartphone to a microscope to acquire images of slides. Its mobile technology then stitches the images together to produce a whole slide and securely transfers the images via a service called BitTorrent Sync (which enables the app to transfer large files over bad Internet connections) to a pathologist in the U.S. for analysis and diagnosis. TeamLiveLonger also built an electronic health record for mobile devices that makes it easy for health workers to keep cases updated and know when people come back to the clinic to receive results or treatment.\u003c/p>\n\u003cp>The Pap smear may not be the best method of screening for cervical cancer but it does hold the dubious distinction of being the most prevalent one. Innovation after innovation has emerged in this space over the past 20 years but their adoption is much faster in the developing world without the entrenched legacy of the Pap smear to overcome.\u003c/p>\n\u003cp>While women in Haiti, India, Nicaragua and Uganda get screened for cervical cancer with a brush and a mobile phone, it looks like women in the U.S. will have to endure the speculum for the foreseeable future.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/Mm5ogJT-M9k'\n title='//www.youtube.com/embed/Mm5ogJT-M9k'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/1819/smartphones-vinegar-and-the-future-of-cervical-cancer-screening","authors":["6620"],"programs":["futureofyou_54"],"series":["futureofyou_219"],"categories":["futureofyou_1","futureofyou_73"],"tags":["futureofyou_213","futureofyou_34","futureofyou_61","futureofyou_80","futureofyou_173","futureofyou_214","futureofyou_216","futureofyou_218","futureofyou_217","futureofyou_215"],"featImg":"futureofyou_2081","label":"futureofyou_54"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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