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Pap Test Warning in Ad Campaign May Mislead

Posted on: Wednesday, 9 November 2005, 18:00 CST

By Connie Lauerman, Chicago Tribune

Nov. 9--In a television ad that recently hit the airways in Chicago and Boston, five women sit around talking about their health.

"If your Pap test is normal, you don't have to worry about cervical cancer, right?" one woman says. The others agree. "Wrong!" says the first woman. "The Pap test isn't enough, there's another test, an HPV test."

Print ads are also on tap for a string of magazines, including Cosmopolitan, Real Simple, O, The Oprah Magazine and Woman's Day.

Maybe you've seen one of the ads. They're rather alarming. They say that the Pap test might be failing you, that you should also be getting an HPV test to screen for human papilloma virus.

Should you?

Digene Corp., the company that makes the HPV test and pays for the ads, obviously thinks so.

But the ads are a little misleading, starting with the fear factor, some doctors say.

"Your chance of developing heart disease and other diseases far outweigh the risk of getting cervical cancer," says Dr. Abbie Roth, an obstetrician-gynecologist at Northwestern Memorial Hospital.

The American Cancer Society estimates that 10,370 women in the U.S. will be diagnosed with cervical cancer this year, compared with an estimated 211,240 cases of breast cancer and 22,220 cases of ovarian cancer.

The Pap test, which came into widespread use after World War II, has substantially reduced cervical cancer rates. Although HPV is linked to cervical cancer, most women who get cervical cancer have not had regular Pap tests, according to the Centers for Disease Control and Prevention.

Furthermore, the HPV test can only be administered along with the Pap test, which supplies the cervical-cell sample from which lab technicians extract DNA to look for the papilloma virus.

Your doctor may already be administering the HPV test, if he or she is no longer using the old version of the Pap test for which cervical cells were smeared on a slide.

Roth says that most gynecologists now use the newer liquid-based Pap test that would not require obtaining a second cell sample for an HPV test. If a specific abnormality is detected in the Pap test, the lab will "reflexively" test for HPV, Roth said.

Otherwise, a doctor must request an HPV test. Roth said it is costly and many insurance plans do not cover testing for sexually transmitted diseases, so if patients insist on the HPV test there may be a surprise when the bill arrives.

The average reimbursement paid by insurance companies for the HPV test is about $50, compared with $25 for a Pap test. But laboratory fees vary greatly, and the out-of-pocket cost for the HPV test averages $50 to $200. In the long run, economic studies show that using the HPV test with the Pap test costs the health system less than Pap tests alone because fewer additional procedures are needed later.

Dr. Michael Regan, a gynecologist-oncologist at Advocate Christ Medical Center in Oak Lawn, calls the HPV test "useful," but he defends the Pap test as a screening tool for detecting abnormal precancerous cells, or dysplasia.

Dysplasia can be successfully treated if discovered early, he said. That's why women are urged to have annual Pap tests.

Human papilloma virus, a sexually transmitted infection that sometimes causes warts in the genital area, plays a major role in causing cervical cancer, Regan says. But there are multiple types of the virus, some of which go away on their own, and only some types of the virus are linked to cervical cancer.

Roth cautions that cervical cancer also can develop even without HPV infection and says that smoking is another risk factor, along with early sexual activity, multiple partners and partners who have had multiple partners.

"I have a couple of patients who are nuns who have precancerous changes in the cervix and they swear they've never had sex and they have no evidence of HPV," Roth says.

The FDA initially approved Digene's HPV test in 1999 only for women with borderline abnormal Pap tests, a result found in about 3 million women each year. Four years later, the FDA extended use of the HPV test as an adjunct to Pap tests for women age 30 and older.

Women have grown complacent if they get a yearly Pap test, says Pam Rasmussen, Digene's vice president for corporate communications. "We need to get the word out that you increase your protection 100 percent if you have the HPV test at the same time."

Because HPV is transmitted through sex, Rasmussen says, many doctors shy away from discussing that topic and consequently have not started using the HPV test.

Roth agrees that "probably many doctors are not comfortable discussing sexually transmitted infections with patients," but she wishes the Digene TV ad mentioned that HPV is a sexually transmitted disease to help open the door to discussion of patients' sexual histories.

Most women (88 percent) rely on their doctors to learn about gynecological issues, according to a random sample of 1,000 women ages 18 to 65 surveyed for Association of Reproductive Health Professionals in February and paid for with an unrestricted education grant from Digene, based in Gaithersburg, Md. Only 19 percent of the women surveyed said that their doctor talked to them about cervical cancer and HPV.

Another national survey of doctors, nurse midwives, physician assistants and nurse practitioners, conducted for the CDC this year, revealed that 13 percent of those surveyed were not aware of the HPV test.

A little less than half of those professionals who used the HPV test said they had personally discussed HPV or HPV-related conditions during routine checkups. Printed materials about the virus were infrequently used.

At least the HPV test ad is getting people talking. Roth says many patients have been requesting the test, but sometimes it's not the women who need it most.

"My patients in their 20s and 30s who have had 15 partners and smoke and do other things need to listen to the ad," she says.

'DOESN'T HAVE TO HAPPEN TO YOU': Five years ago Christine Baze thought she was on her way to rock stardom when tragedy struck.

After years of doing "everything in her power" to take care of her health, including yearly Pap tests, Baze was diagnosed with invasive cervical cancer. Ten days later she had a radical hysterectomy and then several rounds of chemotherapy and internal radiation therapy.

Baze survived her illness and the deep depression that followed and decided to use her music to help other women avoid an ordeal like hers.

"I was one of those statistics that fell outside the accuracy rate [of the Pap test]," she says. Baze, 36, wishes her doctor had switched to the more sensitive liquid-based Pap test earlier, and she wishes she had been given an HPV test.

She is unable to have children and the radiation treatment has left her with atrophied tissue in her vagina and "inconvenient and uncomfortable" problems with her digestive system.

"I had never had a sexually transmitted disease in my life," Baze says. "I met my husband when I was very young. I never had a gynecologic issue at all. Then to go from years of normal Pap tests to invasive cervical cancer didn't seem real."

Baze says she considered herself "fairly educated," but she knew little about her cervix, HPV or differences in the reliability of Pap tests.

Now she is using her music to spread the word to women about the importance of being informed and knowing your HPV status.

Baze, who lives in Boston, organizes an annual Yellow Umbrella Tour, a national concert series with several other singer-songwriters to entertain as well as educate.

The tour, sponsored by Digene Corp., makers of the HPV test, and Quest Diagnostics, played two venues in Chicago recently.

"There's a stigma associated with HPV," Baze says. "People think it means you're promiscuous or you haven't been taking care of yourself.

"I feel very comfortable putting my voice and story out there. I am proud to use my voice to say: 'Ladies: This doesn't have to happen to you.'"

--Connie Lauerman

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Copyright (c) 2005, Chicago Tribune

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DIGE,

Source: Chicago Tribune

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