Read Dr. Welt's Perspective

"Pap smears are not nearly as accurate as I thought they were. They miss as many as 50% of cervical cancers."

- Dr. Welt

Dr. Welt's Perspective

In September 2005, I began routine screening with the HPV test for women over 30, and today, all five physicians in my practice do the same. There is abundant data supporting HPV testing for primary screening and now, based on my personal experience, I have a great deal of confidence in the value of the HPV test.

Micheline, a 38-year-old, long-time patient who was pregnant following in-vitro fertilization (IVF), came in for a check-up in July 2003. She only had a Pap at that visit because at that time, our practice ordered an HPV test only when a Pap result was inconclusive. And Micheline's Pap was normal, just like all of her past smears.

In February 2004, Micheline delivered a healthy baby girl. At her six-week office check-up, she was not given a Pap test. Her next visit, however, happened to be during the first month I began screening all women 30 and over for HPV. She was given both a Pap, which remained normal, and the HPV test, which came back "positive."

If it were not for the test showing she had HPV, I would have sent Micheline on her way. However, I followed the guidelines, and told her to come back six months later for repeat Pap and HPV testing. This time, her Pap indicated that her cervical cells wore moderately or severely abnormal. And again, the HPV test showed that she had a high-risk type of the virus. Thus, I performed a colposcopy exam along with a biopsy in May 2006.

Surprisingly, the results of both exams appeared normal. Nevertheless, I remained suspicious because of the positive HPV test results and abnormal Pap reading. I decided the best option was to perform a procedure that allowed me to remove a wedge of deeper tissue, which diagnosed invasive adenocarcinoma. In August 2006, Micheline had a complete hysterectomy and is now cancer-free.

I have to admit that even though I was skeptical of Micheline's negative colposcopy and biopsy, I was blown away by the results. It is one thing to read stories about the benefits of HPV testing, and another to have the HPV test prove to be a life-saving test for one of your own patients. Micheline's story reinforces my belief in the benefits of routine HPV screening in conjunction with the Pap for women 30 and older. Now, I regularly counsel patients on HPV and generally, they readily accept my recommendation for HPV testing.