As an obstetrician and gynecologist with a diverse patient base in New York City, I see myself not only as a health care professional who treats disease, but as an educator who shows women how to best care for themselves. This is especially true with cervical cancer, where early detection and routine screening is invaluable. We know that when diagnosed early, cervical cancer can be treatable and present with an excellent chance of life-saving outcomes.
The most important lesson is that it all comes down to screening. It’s that simple. For women 30 to 65 years of age, we use what’s called co-testing with both the Pap test, which detects cervical disease on the cervix, and the human papillomavirus (HPV) test, which screens for the presence of the virus. While it’s two tests, for the patient it is just one procedure––it requires only one sample.
Cervical cancer is an equal opportunity disease, meaning anyone with a cervix is at some level of risk. Yet some––through no fault of their own––are more at risk. We see that in the data, which shows that the incidence rate of cervical cancer among Hispanic women is 22% higher than it is for white women, for example, and for African American women 14% higher. Black women in the U.S. are more likely than any other racial or ethnic group to die from cervical cancer and are two times more likely to die from cervical cancer than white women.
There are myriad reasons this is the case, of course, but among them is a need for awareness about the ease and effectiveness of screening by co-testing with the Pap test and HPV test. In fact, a recent article in Contemporary Ob/Gyn noted that a significant contributor to health disparities in cervical cancer is access to, and options for, screening. The message should be clear: Co-testing is the safest and most dependable method for screening for cervical cancer. Women should consult with their physicians to determine what’s best for them.
Recently, the clarity of this message was needlessly muddled by conflicting new guidelines suggesting use of the HPV test alone, skipping the proven efficacy of the Pap test altogether. This is perplexing––and dangerous––because the Pap test, which has been a reliable mainstay for over 50 years, has decreased the rates of cervical cancer by over 70% compared to before the Pap test. The more recent addition of the HPV test adds another layer of information because it identifies the presence of some (not all) HPV strains which may cause cervical cancers.
New clinical findings published just last summer reaffirmed the use of co-testing as the most effective strategy for identifying women at risk. It identified more pre-cancer and cancer cases than either test when used alone. In short, we know co-testing is the best option because science tells us so. HPV testing alone misses twice as much cervical cancer as co-testing, so the risk to women’s health would be exacerbated if the Pap test is eliminated.
Less comprehensive screening will make things worse, not better. It will not narrow the gap in health disparities, and it will not drive down the rate of cervical cancer. Guidelines should guide us in the right direction, they should guide progress. When they disregard science, when they ignore the data, they are misguided.
When it comes to lessons learned we know that protecting co-testing options for women is the best way to optimize women’s health and address/manage/ reduce the risk of cervical cancer for all women.
Kameelah Phillips is a board-certified OB/GYN, lactation consultant and women’s health advocate and educator.