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Years ago a number of articles in the popular press indicated that the Papanicolaou test (aka pap smear) was obsolete, being replaced by vaccines and genetic tests. For example:

New advanced DNA test could make pap smears obsolete (KTRE, Apr 09, 2009):

Women over 30 could drop the annual pap smear and instead get a DNA test every three, five or ten years. The women we talked to said the pap smear does not bother them. "It's better to be safe than sorry, waiting three years is a long time, once a year is pretty accurate," said Becca Tatum, patient.

Making Pap Smear Obsolete (Put in a good word, March 23, 2009):

Research shows that a DNA test is more accurate in finding cervical cancer. if so, this would be a major advancement in cancer detection and could make the pap smear test obsolete. Let’s hope that this research becomes a reality.

No more Pap smears? The new HPV vaccine may relegate cervical swipes to the trash bin. (Salon.com Jan 17, 2007):

On Tuesday, the New York Times reported that the recommended annual Pap test -- which screens for precancerous lesions and typically comes complete with a drafty gown and an icy speculum -- is likely to become less relevant as cervical cancer becomes less common.

And yet, it's apparent that in some places continue to perform the Pap smear, e.g. in this Globe and Mail article with a related question on health care in Canada Is it okay to have two family doctors?.

Is the Pap test really obsolete, as those 2007-2009 articles suggest? Are DNA tests and vaccines superior in every way to pap smear, or does it have other advantages of its own? Is it simply too soon to expect that the new replacement genetic test be prevalent?

Sklivvz
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Brian M. Hunt
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    The HPV Vaccine only covers 4 strains of the HPV virus - the most common. IIRC there's over 30 strains which are cancerous - so the vaccine isn't a guarantee against cervical cancer. There's also a question of cost benefit ration which I don't believe has been addressed. The cost of a pap smear vs the DNA testing - how often will you need the DNA test? – Darwy Aug 15 '11 at 17:47
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    @Darwy: There are multiple vaccines, the most comprehensive being Gardasil I think, which covers four strains. Over 70% of cervical cancer is caused by types 16 & 18. There are 150 types of HPV, and 15 of those types are classified as high risk for causing cancer. The Pap smear costs around $20-25, and in 2009 the HPV genetic tests cost around $50-100, I believe. In any case the claim was that the vaccine & genetic test would make Pap smears obsolete, meaning that the Pap smear would be effectively pointless, or not cost effective. I'm skeptical that it is obsolete. – Brian M. Hunt Aug 15 '11 at 18:37
  • What do you mean by obsolete? Is there an international authority which suggests the correct cancer prevention strategy or is it up to each country? In the second case, are you referring to the US? Otherwise, are we talking about efficacy? Cost? Overall cost, including treatment for missed diagnoses? Refine and flag for reopening. – Sklivvz Aug 16 '11 at 07:47
  • @Sklivvz: Edited; grateful for your thoughts on whether this adequately hones in on a useful definition for “obsolete”. – Brian M. Hunt Aug 16 '11 at 14:32
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    Pharmaceutical companies are driving that propaganda, its in their best interest to do so. PAP is inexpensive and in Your best interest. – Moab Aug 17 '11 at 03:09

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A Globe and Mail article More invasive cervical cancers prevented with new test, posted Nov 02, 2013 states:

In Saturday's issue of the medical journal Lancet there is an article about researchers analyzing data from trials involving 176,464 women in England, Itlay, the Netherlands and Sweden.

"HPV-based screening prevented more invasive cervical cancers than did cytology," Dr. Guglielmo Ronco, from the Center for Cancer Epidemiology and Prevention in Turin, Italy, and his co-authors concluded.

Increased protection against invasive cervical cancer was greatest in women aged 30 to 35 years, and HPV screening every five years proved more beneficial in identifying invasive cancers of the cervix compared with Pap screens done every three years.

...

"With economies of scale that come with broad implementation of primary HPV testing (which will foster competition among various HPV tests) and the lengthening of screen intervals, cervical cancer screening might end up costing countries less money while providing greater safety than with conventional cervical cytology," the commentators concluded.

But they said there are logistical challenges, such as:

  • Settling on the type of HPV screening to use.
  • Determining appropriate screening ages and intervals.
  • Defining triage and management policies for women who are HPV positive.

Which is all to say that at the moment PAP smears are not obsolete. However, the scientific literature suggests that in many cases they may be replaced with HPV screening over the coming years.

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