For Women Over 30, There May Be A Better Choice Than The Pap Smear
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That process was shown to be accurate in multiple studies but is not yet used in clinical practice in the U.S.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The new study, called the HPV FOCAL trial, compared the HPV test with traditional Pap smear screening among 19,000 Canadian women over four years. It adds to a body of research suggesting that HPV testing might be more accurate.\u003c/p>\n\u003cp>\"In our world this study is going to be a pretty big deal, in a good way,\" says \u003ca href=\"https://faculty.mdanderson.org/profiles/kathleen_schmeler.html\" target=\"_blank\" rel=\"noopener\">Dr. Kathleen Schmeler\u003c/a>, a gynecologic oncologist at the University of Texas MD Anderson Cancer Center.\u003c/p>\n\u003cp>Schmeler says that in the U.S., it has been hard to justify replacing the Pap smear with the HPV test because there has not been a head-to-head comparison until now.\u003c/p>\n\u003cp>The issue is not resolved. Some are still skeptical of relying on HPV testing alone, and co-testing, or using both the HPV test and a Pap smear, is still the standard.\u003c/p>\n\u003cp>Cervical cancer screening is essential because nearly \u003ca href=\"https://gis.cdc.gov/Cancer/USCS/DataViz.html\" target=\"_blank\" rel=\"noopener\">13,000 women in the U.S. are diagnosed with cervical cancer\u003c/a> annually. More than 4,000 women die from it, even with screening and treatment.\u003c/p>\n\u003cp>Current screening guidelines from the U.S. Preventive Services Task Force recommend women ages 30 to 65 have a Pap smear every three years, or every five years if an HPV test is done at the same time.\u003c/p>\n\u003cp>But \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/cervical-cancer-screening2\" target=\"_blank\" rel=\"noopener\">draft recommendations issued last fall by USPSTF\u003c/a> recommended just one or the other — a Pap smear or an HPV test — instead of co-testing for women 30 and up. The organization has yet to issue final guidelines. This new study could prove important in deciding practice guidelines.\u003c/p>\n\u003cp>At the start of the HPV FOCAL trial, some women received HPV testing and some had a Pap smear; those in the Pap smear group who tested negative had a second Pap after two years. Both groups were tested again using both methods after four years.\u003c/p>\n\u003cp>Neither method was foolproof. The final round of co-testing found additional abnormal cells in some women who originally tested negative in both groups. Women who originally had the Pap smear were more than twice as likely to have abnormal cells. Of the women who tested negative on the HPV test only 22 women showed abnormal cells (grade 3 or worse), while from the Pap smear group, 52 women ended up with abnormal cells.\u003c/p>\n\u003cp>\"What our study shows is that by using HPV testing, we detect precancerous lesions earlier,\" says \u003ca href=\"http://www.spph.ubc.ca/person/gina-ogilvie/\" target=\"_blank\" rel=\"noopener\">lead author Dr. Gina Ogilvie\u003c/a>. \"If women have a negative HPV test, they are significantly less likely to have a precancerous lesion four years later, meaning we can extend screening time.\"\u003c/p>\n\u003cp>Ogilvie, a professor of medicine at the University of British Columbia, says this study shows that the real value of co-testing actually comes from the HPV test, not the Pap smear.\u003c/p>\n\u003cp>Studies like this one could lead to a change in guidelines, according to Dr. Chris Zahn, the vice president of practice for the American College of Obstetricians and Gynecologists.\u003c/p>\n\u003cp>\"This study adds evidence to those that evaluated use of HPV as a primary screening modality, and the findings support the use of HPV only as a primary screen,\" he wrote in an email.\u003c/p>\n\u003cp>Even if guidelines do change for women over 30, the Pap smear is still important for women ages 21-29. They can't rely on HPV testing, Schmeler says, because almost everyone in that age group will contract HPV, and in many cases it goes away on its own. If the virus persists until their 30s, that's where problems come in.\u003c/p>\n\u003cp>\"If you tested everyone for HPV in their 20s, they are almost all going to be positive, but there's going to be all of this intervention that's not needed,\" she says.\u003c/p>\n\u003cp>Moving away from co-testing may not be a good idea, says \u003ca href=\"http://www.colposcopycenter.com/MeetDrMarkSpitzer.html\" target=\"_blank\" rel=\"noopener\">Mark Spitzer\u003c/a>, an OB-GYN and past president of American Society for Colposcopy and Cervical Pathology. He wrote in an email that this new study actually shows the small but significant benefit of co-testing. He cites the small group of women who had abnormal cells discovered through a Pap smear at the end of the study period.\u003c/p>\n\u003cp>\"In the U.S., co-testing is currently the recommended gold standard, and neither doctors nor their patients should be willing to give up the added benefit you get from screening with a Pap test and HPV test together,\" he says.\u003c/p>\n\u003cp>\u003ca href=\"https://medicine.umich.edu/dept/family-medicine/diane-m-harper-md-mph-ms\">Dr. Diane Harper,\u003c/a> a professor of medicine who researches HPV at the University of Michigan, argues that the study was \"extraordinarily well done\" and moving away from co-testing could result in a decrease of false positives.\u003c/p>\n\u003cp>\"The whole reason for [co-testing] is that you get a slight improvement in sensitivity,\" Harper says. \"But your false positive rate blows up. It's up to 30 percent of people [who] are falsely positive.\"\u003c/p>\n\u003cp>Women who have a positive Pap smear generally get a colposcopy, which is an even closer \u003ca href=\"https://www.mayoclinic.org/tests-procedures/colposcopy/about/pac-20385036\" target=\"_blank\" rel=\"noopener\">examination of the cervix, vagina and vulva \u003c/a>for signs of disease.\u003c/p>\n\u003cp>A false positive could mean going through a biopsy during a colposcopy. Biopsies come with risks like bleeding, infection and pelvic pain, according to the Mayo Clinic. Harper says false positives bring unnecessary costs and fears to patients.\u003c/p>\n\u003cp>\"That's a lot of women that are unnecessarily worried,\" she says.\u003c/p>\n\u003cp>Women can get a clear result from a simple HPV test and those who receive a negative result will be able to trust those results for several years, she says.\u003c/p>\n\u003cp>\"It's really amazing — there's no other test that gives us this level of reassurance for that period of time for a cancer,\" Harper says.\u003c/p>\n\u003cp>Pap smears rely on the human eye to get results, she says, and it's far preferable to detect problems on a molecular level.\u003c/p>\n\u003cp>One caution about the study findings, says \u003ca href=\"https://www.uclahealth.org/carol-mangione\" target=\"_blank\" rel=\"noopener\">Dr. Carol Mangione\u003c/a>, a USPSTF task force member and UCLA professor of medicine, is that screening — either kind — is what saves lives. She says the method of testing comes second to being sure that all women, \u003ca href=\"https://www.npr.org/sections/health-shots/2017/10/11/556895389/could-making-cancer-screening-simpler-increase-womens-risk\" target=\"_blank\" rel=\"noopener\">especially high-prevalence groups like black and Hispanic women\u003c/a>, are able to get the testing they need.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"Most cases of cervical cancer happen in women who have not been regularly screened, or who have been screened, but don't have access to appropriate treatment,\" she says. \"When we think about cervical cancer screening, we want to think about it in the framework of how do we get this test in the hands of all women?\"\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+Women+Over+30%2C+There+May+Be+A+Better+Choice+Than+The+Pap+Smear&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"A new study adds weight to the evidence that an HPV test can more accurately test for cervical cancer risk than a Pap smear.","status":"publish","parent":0,"modified":1530854262,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":34,"wordCount":1255},"headData":{"title":"For Women Over 30, There May Be A Better Choice Than The Pap Smear | KQED","description":"A new study adds weight to the evidence that an HPV test can more accurately test for cervical cancer risk than a Pap smear.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"For Women Over 30, There May Be A Better Choice Than The Pap Smear","datePublished":"2018-07-06T19:00:08.000Z","dateModified":"2018-07-06T05:17:42.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"443213 https://ww2.kqed.org/futureofyou/?p=443213","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/07/06/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear/","disqusTitle":"For Women Over 30, There May Be A Better Choice Than The Pap Smear","source":"Health","nprByline":"Sara Kiley Watson, NPR","nprImageAgency":"BSIP/UIG via Getty Images ","nprStoryId":"625696664","nprApiLink":"http://api.npr.org/query?id=625696664&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"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?ft=nprml&f=625696664","nprRetrievedStory":"1","nprPubDate":"Thu, 05 Jul 2018 16:51:00 -0400","nprStoryDate":"Tue, 03 Jul 2018 14:48:00 -0400","nprLastModifiedDate":"Thu, 05 Jul 2018 16:51:30 -0400","path":"/futureofyou/443213/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>For most women under 65, a visit to the gynecologist often includes an unpleasant necessity: a Pap smear to check for cervical cancer risk.\u003c/p>\n\u003cp>The test involves letting a doctor or nurse scrape cells from the back of the cervix, which are visually inspected for signs of abnormality.\u003c/p>\n\u003cp>There's another way to screen for cervical cancer risk, by directly testing for the human papillomavirus, or HPV, which causes 99 percent of cervical cancer. \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.7464\" target=\"_blank\" rel=\"noopener\"> A study published in JAMA\u003c/a> Tuesday suggests that method might be preferable for women age 30 and over.\u003c/p>\n\u003cp>The FDA in 2014 approved the first HPV test, which tests cervical cells for the presence of HPV.\u003c/p>\n\u003cp>HPV testing also can be done on samples of vaginal and cervical secretions that clinicians or women themselves gather with a swab — a less invasive process than the Pap. That process was shown to be accurate in multiple studies but is not yet used in clinical practice in the U.S.\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>The new study, called the HPV FOCAL trial, compared the HPV test with traditional Pap smear screening among 19,000 Canadian women over four years. It adds to a body of research suggesting that HPV testing might be more accurate.\u003c/p>\n\u003cp>\"In our world this study is going to be a pretty big deal, in a good way,\" says \u003ca href=\"https://faculty.mdanderson.org/profiles/kathleen_schmeler.html\" target=\"_blank\" rel=\"noopener\">Dr. Kathleen Schmeler\u003c/a>, a gynecologic oncologist at the University of Texas MD Anderson Cancer Center.\u003c/p>\n\u003cp>Schmeler says that in the U.S., it has been hard to justify replacing the Pap smear with the HPV test because there has not been a head-to-head comparison until now.\u003c/p>\n\u003cp>The issue is not resolved. Some are still skeptical of relying on HPV testing alone, and co-testing, or using both the HPV test and a Pap smear, is still the standard.\u003c/p>\n\u003cp>Cervical cancer screening is essential because nearly \u003ca href=\"https://gis.cdc.gov/Cancer/USCS/DataViz.html\" target=\"_blank\" rel=\"noopener\">13,000 women in the U.S. are diagnosed with cervical cancer\u003c/a> annually. More than 4,000 women die from it, even with screening and treatment.\u003c/p>\n\u003cp>Current screening guidelines from the U.S. Preventive Services Task Force recommend women ages 30 to 65 have a Pap smear every three years, or every five years if an HPV test is done at the same time.\u003c/p>\n\u003cp>But \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/cervical-cancer-screening2\" target=\"_blank\" rel=\"noopener\">draft recommendations issued last fall by USPSTF\u003c/a> recommended just one or the other — a Pap smear or an HPV test — instead of co-testing for women 30 and up. The organization has yet to issue final guidelines. This new study could prove important in deciding practice guidelines.\u003c/p>\n\u003cp>At the start of the HPV FOCAL trial, some women received HPV testing and some had a Pap smear; those in the Pap smear group who tested negative had a second Pap after two years. Both groups were tested again using both methods after four years.\u003c/p>\n\u003cp>Neither method was foolproof. The final round of co-testing found additional abnormal cells in some women who originally tested negative in both groups. Women who originally had the Pap smear were more than twice as likely to have abnormal cells. Of the women who tested negative on the HPV test only 22 women showed abnormal cells (grade 3 or worse), while from the Pap smear group, 52 women ended up with abnormal cells.\u003c/p>\n\u003cp>\"What our study shows is that by using HPV testing, we detect precancerous lesions earlier,\" says \u003ca href=\"http://www.spph.ubc.ca/person/gina-ogilvie/\" target=\"_blank\" rel=\"noopener\">lead author Dr. Gina Ogilvie\u003c/a>. \"If women have a negative HPV test, they are significantly less likely to have a precancerous lesion four years later, meaning we can extend screening time.\"\u003c/p>\n\u003cp>Ogilvie, a professor of medicine at the University of British Columbia, says this study shows that the real value of co-testing actually comes from the HPV test, not the Pap smear.\u003c/p>\n\u003cp>Studies like this one could lead to a change in guidelines, according to Dr. Chris Zahn, the vice president of practice for the American College of Obstetricians and Gynecologists.\u003c/p>\n\u003cp>\"This study adds evidence to those that evaluated use of HPV as a primary screening modality, and the findings support the use of HPV only as a primary screen,\" he wrote in an email.\u003c/p>\n\u003cp>Even if guidelines do change for women over 30, the Pap smear is still important for women ages 21-29. They can't rely on HPV testing, Schmeler says, because almost everyone in that age group will contract HPV, and in many cases it goes away on its own. If the virus persists until their 30s, that's where problems come in.\u003c/p>\n\u003cp>\"If you tested everyone for HPV in their 20s, they are almost all going to be positive, but there's going to be all of this intervention that's not needed,\" she says.\u003c/p>\n\u003cp>Moving away from co-testing may not be a good idea, says \u003ca href=\"http://www.colposcopycenter.com/MeetDrMarkSpitzer.html\" target=\"_blank\" rel=\"noopener\">Mark Spitzer\u003c/a>, an OB-GYN and past president of American Society for Colposcopy and Cervical Pathology. He wrote in an email that this new study actually shows the small but significant benefit of co-testing. He cites the small group of women who had abnormal cells discovered through a Pap smear at the end of the study period.\u003c/p>\n\u003cp>\"In the U.S., co-testing is currently the recommended gold standard, and neither doctors nor their patients should be willing to give up the added benefit you get from screening with a Pap test and HPV test together,\" he says.\u003c/p>\n\u003cp>\u003ca href=\"https://medicine.umich.edu/dept/family-medicine/diane-m-harper-md-mph-ms\">Dr. Diane Harper,\u003c/a> a professor of medicine who researches HPV at the University of Michigan, argues that the study was \"extraordinarily well done\" and moving away from co-testing could result in a decrease of false positives.\u003c/p>\n\u003cp>\"The whole reason for [co-testing] is that you get a slight improvement in sensitivity,\" Harper says. \"But your false positive rate blows up. It's up to 30 percent of people [who] are falsely positive.\"\u003c/p>\n\u003cp>Women who have a positive Pap smear generally get a colposcopy, which is an even closer \u003ca href=\"https://www.mayoclinic.org/tests-procedures/colposcopy/about/pac-20385036\" target=\"_blank\" rel=\"noopener\">examination of the cervix, vagina and vulva \u003c/a>for signs of disease.\u003c/p>\n\u003cp>A false positive could mean going through a biopsy during a colposcopy. Biopsies come with risks like bleeding, infection and pelvic pain, according to the Mayo Clinic. Harper says false positives bring unnecessary costs and fears to patients.\u003c/p>\n\u003cp>\"That's a lot of women that are unnecessarily worried,\" she says.\u003c/p>\n\u003cp>Women can get a clear result from a simple HPV test and those who receive a negative result will be able to trust those results for several years, she says.\u003c/p>\n\u003cp>\"It's really amazing — there's no other test that gives us this level of reassurance for that period of time for a cancer,\" Harper says.\u003c/p>\n\u003cp>Pap smears rely on the human eye to get results, she says, and it's far preferable to detect problems on a molecular level.\u003c/p>\n\u003cp>One caution about the study findings, says \u003ca href=\"https://www.uclahealth.org/carol-mangione\" target=\"_blank\" rel=\"noopener\">Dr. Carol Mangione\u003c/a>, a USPSTF task force member and UCLA professor of medicine, is that screening — either kind — is what saves lives. She says the method of testing comes second to being sure that all women, \u003ca href=\"https://www.npr.org/sections/health-shots/2017/10/11/556895389/could-making-cancer-screening-simpler-increase-womens-risk\" target=\"_blank\" rel=\"noopener\">especially high-prevalence groups like black and Hispanic women\u003c/a>, are able to get the testing they need.\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>\"Most cases of cervical cancer happen in women who have not been regularly screened, or who have been screened, but don't have access to appropriate treatment,\" she says. \"When we think about cervical cancer screening, we want to think about it in the framework of how do we get this test in the hands of all women?\"\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+Women+Over+30%2C+There+May+Be+A+Better+Choice+Than+The+Pap+Smear&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443213/for-women-over-30-there-may-be-a-better-choice-than-the-pap-smear","authors":["byline_futureofyou_443213"],"series":["futureofyou_219"],"categories":["futureofyou_1060","futureofyou_1","futureofyou_73"],"tags":["futureofyou_190","futureofyou_1056","futureofyou_214","futureofyou_275"],"collections":["futureofyou_1093"],"featImg":"futureofyou_443214","label":"source_futureofyou_443213"},"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":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Smartphones, Vinegar and the Future of Cervical Cancer Screening","datePublished":"2015-04-27T17:40:52.000Z","dateModified":"2015-04-27T19:53:13.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"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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