Since the end of World War II, Pap smear screening has markedly reduced the incidence and mortality of invasive cervical cancer in the United States, Canada, UK, Australia, and Western Europe. Interestingly, it’s one of the few widespread screening tests that have never been evaluated in a randomized clinical trial,yet it has undoubtedly forever changed women’s healthcare.
However, we may have reached the maximum benefit of Pap-based cervical cancer screening and have learned quite a bit about this diagnostic test in the last 20 years. Unfortunately, a single Pap smear has a false negative rate of 50% (yes, 50%!). That might be even higher in areas where prevalence of disease is low (i.e., an over-screened population or one with high HPV vaccination rates).