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Watson's For Women Over 30, There May Be A Better Choice Than The Pap Smear

Emily Watson, writing for NPR, describes medical research by Ogilvie, vanNiekerk, & Krajden. This research provides a timely, topical example of false positives, false negatives, medical research, and gets your students thinking a bit more flexibly about measurement.

This research provides valuable information about debate in medicine: What method of cervical cancer detection is most accurate: The traditional Pap smear, or an HPV screening? The Pap smear works by scraping cells off of a cervix and having a human view and detect abnormal cervical cancer cells. The HPV test, indeed, detects HPV. Since HPV causes 99% of cervical cancers, its presence signals a clinician to perform further screen, usually a colonoscopy. The findings: Women over 30 benefit more from the HPV test.

How to use this example in class:

- This is a great example of easy-to-follow  research methodology and efficacy testing in medicine. A question existed: Which is better, Pap or HPV test? The question was answered by a n = 19K study that lasted for four years.

-Sometimes correlation does, ultimately, imply causation. Since we know that HPV causes 99% of cervical cancers, detection of HPV in women over 30 does provide a strong warning of possible cervical cancer.

-This is also a good example of separating the signal from the noise: There are different recommendations for different ages. Different diagnoses for different age groups: This change is recommended for women 30 and over. Not younger. Why? HPV is so prevalent in women under 30 that the test loses its ability to diagnose. Typically, HPV goes away on its own. As such, if you still test positive in your 30s, it is an indicator of illness.

-The NPR piece describes false negatives. Some women who a) test negative for HPV AND b) have a clean the Pap Smear still have abnormal cervical cells. But but the Pap smear test had more false negatives than did the HPV test.


-In psychology, we are tasked with operationalizing all manner of abstract ideas, like aggression and well-being. I think this example is a cool example of operationalizing cancer. When scientists create a way to detect cervical cancer, how do they operationalize "Cervical Cancer"? The obvious answer is the presence or absence of cervical cancer cells, right? But if we understand causality, we understand that the presence or absence of HPV virus acts as a good proxy.

-High stake statistics and research methodology that saves lives and improves diagnostics.

-I teach many students in pre-medical professional majors. This is a medical example. I also teach many traditionally aged college students who should know more about their own health, and I hope this example may serve to better inform my female students about what exactly is happening at their annual gyno exam.

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