How to Avoid Cervical Cancer? Doctor: there is a better examination than a Pap smear

Polish women believe that regular cytology will protect them against cervical cancer. Meanwhile, the sensitivity of the test is just over 60 percent. – Medicine has more effective tools to detect HPV – argues Dr. Maciej Mazurec, founder of the Corfamed Women’s Health Center in Wrocław.

1. The purpose of the cytology is to inform the patient whether her body is developing a cancerous disease caused by the HPV virus
2. This is the most popular study of this type, although – as Dr. Mazurec argues – not the most effective
3. As much as 90 percent equals the effectiveness of HPV tests
4. Why, then, the above-mentioned tests, despite their unquestionable effectiveness, are not as popular in Poland as they deserve?
5. More information can be found on the Onet homepage

Why is HPV testing not as popular as it deserves?

There is a belief in Polish society that regular cytology is a guarantee of effective protection against cervical cancer. The basis for this belief is the fact that thanks to the examination, the patient receives information whether her body is developing (or cannot begin to develop) a disease caused mainly by oncogenic types of HPV. At the same time, it has been known for years how insufficiently effective cytology actually is a screening method.

In the most frequently performed conventional cytology, on which the national organized population program operating in Poland in 2006-2016 was based, the sensitivity of cytological screening is just over 60%. A slightly higher detectability is characteristic of liquid cytology (LBC), which is able to detect about 70% of precancerous conditions. Against this background, the effectiveness of HPV tests, at the level of over 90%, is incomparably higher. Why, then, the above-mentioned tests, despite their unquestionable effectiveness, are not as popular in Poland as they deserve? Dr. Maciej Mazurec, the founder of the Corfamed Women’s Health Center in Wrocław, explains that answers should be sought both on the part of doctors and patients themselves, but also for reasons beyond their control.

Responsibility of doctors

In the first place, the doctors themselves are responsible for the relatively low popularity of human papillomavirus tests. Why? Because of a few reasons. Firstly, because the level of knowledge of gynecologists and obstetricians has not yet reached the stage of fully understanding the fundamental difference between the effectiveness and hence sensitivity of HPV vs. Pap smear tests. Although the statistics presented above are unambiguous, a large group of doctors simply lacks awareness of this subject, explains a Corfamed specialist.

The second reason on the part of doctors is the different level of complexity of patient supervision in situations where the cytology or the HPV test is used. These are two completely different studies that require separate knowledge. It is inconvenient for doctors because a different procedure requires abandoning many years of habits and re-education, which must be undertaken in such a situation. For many gynecologists and obstetricians, opening up to this process is an obstacle they are afraid to overcome.

Patients’ responsibility

Unfortunately, the patients themselves are also partly responsible for the relatively low popularity of HPV tests. As with doctors, this is mainly for two reasons. The first is the insufficient level of knowledge on the subject – says Dr. Maciej Mazurec. Of course, the low level of awareness doesn’t come out of nowhere. It has its direct justification mainly in the media, where the main information reaching the woman is the misleading message that only a regular smear test is an effective protection against cervical cancer.

The second element of the patients’ responsibility is deeply rooted, in fact, in their psyche. Women are able to bear a positive, and therefore abnormal, cytology result with dignity. As a rule, he immediately mobilizes to act and take care of himself. However, in the case of a positive HPV test result, the situation is usually quite different.

Let’s put it bluntly: HPV is sexually transmitted. It is therefore automatically associated with venereal disease, which can be stigmatizing. Meanwhile, taking into account the omnipresence of the virus in society (about 80% of us will encounter the human papillomavirus in their lives), the overwhelming majority of sexually active people have had or will have contact with it – explains the Corfamed Women’s Health Center gynecologist.

While after a positive Pap test a woman is ‘only’ worried about whether she has cancer, in the case of a similar HPV test result, the question arises as to where she developed an STI from. That is why women often consciously choose a less sensitive cytology – even when they are aware of the existence of a much more effective alternative.

System Responsibility

The third reason that is not conducive to the popularization of knowledge about HPV tests are systemic issues, and therefore independent of neither the doctors nor the patients. The basis of the population-based organized screening (patients were invited to the research) conducted in Poland until 2016 was conventional cytology. In the case of currently functioning opportunistic screening, a patient who wants to participate in it has to come to the examination herself, which, however, still remains a conventional cytology.

On a population scale, HPV tests are not reimbursed in Poland as primary screening tests (those that are performed first in the entire study population). Therefore, the burden of financing them rests with the private funds of each of the patients, which for understandable reasons limits the scale of their implementation.

Conventional cytology remains the cheapest test for the public payer. Adding to this insufficient level of medical knowledge (but also the patients themselves), reluctance to assimilate and introduce new solutions, as well as fear of the feeling of stigmatization on the part of women with a positive HPV result, explains the unwavering attachment to cytology.

At the Corfamed Women’s Health Center, HPV tests have been performed since 2004 – says Dr. Maciej Mazurec. Initially as a complement to the cytological test, and since 2012 together with the cytology as an integral part of the combined test / cotesting, which is the most effective form of secondary prevention of cervical cancer. After nearly ten years of using this test in our Center, we have achieved success in the fact that our patients are no longer afraid to undergo the most effective screening test, in the vast majority of cases choosing a test based on the detection of HPV infections.

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