Pap smear criticisms anger doctors ... , May 26 5/26/2008 11:04:05 AM

Pap smear criticisms anger doctors, cancer groups

PM - Friday, 23 May , 2008 18:46:00
Reporter: Emily Bourke

MARK COLVIN: A call for changes to Australia's pap smear program has left some in the cancer field scratching their heads.

The former director of the New South Wales Cervical Screening Program Gerry Wain says women aged under 24 should not bother getting a pap test, and Dr Wain says pap smears should be conducted every three years, not the recommended two years.

Cancer support groups, survivors of cervical cancer and even oncologists are angry at the suggestion that pap smears for young women are a waste of time and they're concerned about the numbers of women who are not being screened at all.

Emily Bourke reports.

EMILY BOURKE: The current advice from the federal health department is that all women aged over 18 who have ever had sex should have a pap smear every two years and if a woman starts sexual activity at a younger age, screening should begin earlier.

But Dr Gerry Wain, the director of gynaecological oncology at Sydney's Westmead Hospital says testing women and even teenagers every two years is unnecessary.

GERRY WAIN: Most of the abnormalities that are picked up in younger women, and I mean by younger women, women in their early 20s, most of those reflect acute HPV(Human papillomavirus) infections and we don't really need to be detecting all of those. Those will largely resolve if they're left alone and they only become important if the HPV infections and the changes on the cervix stay there for longer periods.

So, that's why it's most important that we use the pap smear appropriately in women in that older age group. We've got the vaccine now which will reduce the number of abnormalities in those women. And like many other parts of the world we really should be not bothering those younger women with these pap smears.

CHRISTINE EVELY: As far as I'm concerned, if I hadn't been having pap smears annually, I wouldn't be here talking to you now.

EMILY BOURKE: Christine Evely from the Cervical Cancer Support Group was diagnosed in her late 20s. She says pap smears should begin early so they become a habit for women.

CHRISTINE EVELY: The longer there is between pap smears, the easier it is to forget to have them and the less of a habit it becomes. So, you know, if you're having pap smears either annually or every two years then it becomes just a part of your normal health care prevention.

EMILY BOURKE: Dr Andrew Penman from the Cancer Council of New South Wales says there are already concerns about the shortcomings of the existing program.

ANDREW PENMAN: If you look at world guidelines for the International Agency for Research on Cancer it's suggesting yes that maybe we shouldn't start cervical screening until 25 and maybe we only need to do it every three years.

How we get to that in Australia is the important issue. It's not clear to me that it's two or three years that's preventing women from being screened, because at three years we still have 30 per cent of women unscreened.

EMILY BOURKE: But Dr Gerry Wain is standing by his call and he doesn't think focusing on older women or changing the pap smear tests to ever three years would lead to an increase in cervical cancer rates.

GERRY WAIN: It costs about $150-million a year, the screening program. A lot of that could be directed and more concentrated and become much more an effective program. We really have to be honest about what benefit the screening program is getting for these young women.

I think it's probably making them have too many smears at a time when they're young and too early, and by the time they get to the point where they'll most benefit from the screening they'll have lost interest in the screening program.

EMILY BOURKE: But Professor Michael Quinn, the director of oncology at Melbourne's Royal Women's hospital disagrees.

MICHAEL QUINN: In the United Kingdom they have changed the age cut-off for starting pap smears from 18 to 25, but they have acknowledged in the UK program that that means that there are going to be more young women dying from cancer of the cervix.

So they've made a public health position saying it's cheaper this way and we're going to save money and there are going to be lives lost but so be it.

EMILY BOURKE: And he's adamant the two-year tests should stay and younger women should continue to be included in the program.

MICHAEL QUINN: When we review the figures for instance in our own hospital and we've just done this, there are a substantial number of young women who get high grade abnormalities. At least 20 to 30 per cent of those high-grade abnormalities will eventually go on to cancer.

So every test for any woman is going to be valuable. If someone says it's a waste of time, I don't know whose time is being wasted here - certainly not the young women's, and certainly not the doctors'.

source: abc.net.au

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