Is PAP smear era coming to an end?

Abstract

After the discovery of the role human papilloma virus (HPV) plays in cervical cancer development we have witnessed a change in the conception and interpretation of cervical cancer prevention processes. Primary prevention gained a new tool in the form of HPV vaccines. Secondary prevention, which is cervical intraepithelial neoplasia (CIN) detection, acquired a new diagnostic method – HPV test. Studies were initiated in order to determine the usefulness of HPV tests in cervical cancer prevention and screening. They revealed that DNA HPV test used in screening has higher sensitivity in CIN detection than PAP smear and that HPV negative patients are better and longer protected against developing cervical cancer in comparison to women with normal PAP smear results. HPV tests also possess a predictive value, which detects women more susceptible to developing cervical cancer in the future. PAP smear does not have a predictive value; it only detects a presence or absence of neoplasia at this particular time. These results clearly indicate that the era of classic PAP smear is indeed coming to an end, replaced by a new primary CIN screening tool – HPV test. The entire cervical cancer screening system must therefore be redefined and reorganized from the ground up.