Your Health


On a Thursday morning, you're listening to MORNING EDITION from NPR News. I'm Steve Inskeep.


And I'm Renee Montagne.

And in Your Health today, sex. We'll hear from teens about what makes a good birds-and-bees talk.

But first, we've heard a lot lately about the new HPV vaccine for teens. Now, for women 30 and older, doctors have another strategy for preventing cervical cancer.

NPR's Allison Aubrey reports.

ALLISON AUBREY: The annual screening test that women all know about is the Pap smear - a very imperfect test that looks for precancerous lesions on the cervix. Forty-one-year-old Jodi McKinney of Bethlehem Township, New Jersey, has had a Pap smear every year for two decades. And she says she was always relieved by the results.

JODI MCKINNEY: Everything always came back negative. So, you know, everything was fine.

AUBREY: Or so she thought. But about a year ago, her gynecologist suggested adding another test that the American Cancer Society and other doctors' groups recommend.

It's the HPV test, where a painless swab taken during a pelvic exam can detect an active infection with the virus. McKinney says, of course, she'd heard about the HPV vaccine, but she'd never heard about this test for the virus until the nurse handed her an informational pamphlet.

MCKINNEY: I really had no idea what it was until I saw that pamphlet and read about it. And then I consented right away to have it done - luckily.

AUBREY: Even though her Pap test came back normal, her HPV test was positive. That meant she was infected with at least one strain of the virus that sometimes leads to cancer. It turns out traditional Pap smears miss up to 40 percent of precancerous lesions. McKinney's gynecologist, Dr. Mamie Bowers, explained that reading Pap smears isn't easy; they're subjective.

MAMIE BOWERS: They're a test that relies on a human being to read a slide and look for cellular changes. The sampling may not always be good, so there's a lot of points where the test can fall short and not be as reliable as we'd like for it to be.

AUBREY: At least in the short term, annual Pap smears will eventually pick up most slow-growing cancers. But it may be too late. The beauty of the new HPV test is that it tells you right away if you're infected with a virus that could cause the cancer. In Jodi McKinney's case, when a follow-up biopsy revealed she did have precancerous lesions, she opted for surgery to remove them.

MCKINNEY: If I hadn't consented to that test - my Pap had come back as everything being good - it would have just continued to, you know, cells would have continued to grow and I would've had no idea, absolutely no idea. So I was very fortunate.

AUBREY: The HPV test was first introduced seven years ago. But only now is it starting to be used as a primary screening tool. Kaiser Permanente, a large HMO based in California, has found that giving both the Pap and the HPV test to women 30 and older helps detect many more cases of precancerous disease.

Kaiser gynecologist Ruth Shaber is a big fan of using the two tests in combination.

RUTH SHABER: In my own practice and in that of my colleagues, we have found women who otherwise would have just gone through the system with normal Pap smears, not ever suspecting that there was something wrong.

AUBREY: As helpful as the new HPV test is, the American Cancer Society recommends waiting until women are 30 or older before adding it to the Pap smear. That's because nearly half of all women in their 20s have transient HPV infections that their immune systems can fight off.

Tom Wright is a pathologist and HPV expert at Columbia University.

TOM WRIGHT: Most of the women who come into contact with HPV - in fact, 80 percent of women - will spontaneously clear the infection over two years. So the women that we're worried about are the women who have persistent infections.

AUBREY: These are the women who need to be watched closely. But Wright says the vast majority of women don't fall into this category.

WRIGHT: So women who are negative on both the Pap test and the HPV test, they're at such low risk for having cervical disease that we can safely tell them, you don't need to be rescreened for another three years.

AUBREY: This means scores of women are now being told to give up the annual Pap smear - a recommendation that gynecologist Mamie Bowers says many of her patients are reluctant to follow.

BOWERS: That's taking some time to, to educate women about it and get them to the point where they're comfortable with the idea of, what? I don't have to do this every year?

AUBREY: At least not the Pap smear. Remember, doctors check for other things, too.

BOWERS: The full annual exam also involves a breast exam and a pelvic exam, and so the annual exam is not just the Pap smear.

AUBREY: Which is why gynecologists still want women to come in for a visit every year.

Allison Aubrey, NPR News, Washington.

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