You know some patients will have concerns like:
- “I’ve always had a Pap, a Pap every year. What do you mean I do not need a Pap?”
Remember that women for the most part often do not know what a Pap is. They think that any time something has been done down there, they have had a Pap. They do not understand that the Pap is specific to cervical cancer prevention. Though now with liquid-based cytology we have the option to obtain multiple tests from one vial, when it comes to the Pap, women need to understand what a Pap is, and what it isn’t.
- “I have always had a Pap every year. Is it safe to wait 3 years? Five years after a negative Pap and HPV test! How is that possible?”
I think we can use the model of other disease entities that we screen for to help patients understand. Colonoscopy for example. No one questions if you are negative on a colonoscopy and no pre cancer, that you may wait 10 years. No one has had a problem with that. But the “problem” we face with cytology and screening is that we have done such a good job of teaching a Pap every year, the Pap has become the end-all and be-all of the annual exam, and we need to teach women that its not the end-all and be-all. That the annual exam, that the well woman visit, is a chance for clinicians to deal with everything from bone health vaginal health, cardiovascular risk prevention, and that the Pap may or may not be done based on previous history, knowledge of HPV status, and so on.
- The woman who tests HPV positive, and asks, “When did I get this? How long have I had it? Will I ever get rid of it? Will I get cancer?”
Education is vital: We need to help everybody, women and men, understand that most everyone has HPV. It is not a problem of promiscuous people. If you have been sexually active even once in your life you have likely been infected by HPV. The good news is the virus usually goes away on its own. It’s not a time bomb waiting to go off, and if you are HPV positive it doesn’t mean that your partner has been unfaithful. In fact, we are looking for infections that are old and persistent. We are looking for women who may have been infected decades before and are still positive. So whether I am teaching regarding vaccine, HPV testing and screening, or advising young women age 21 to 29 that if their Pap is read in an inconclusive category, they will have a test for a virus, human papillomavirus, HPV.
