Pamela A. Rasmussen, Digene's vice president for corporate communications, said the company helped formulate the ad strategy with Gotham Inc., a New York agency, after extensive focus group research around the country. Rasmussen said the ad campaign's goal was to get people to stop, read, then take action, either by talking to their doctor or visiting the firm's educational Web site.
Digene tried several approaches, quickly realizing women found "soft" ads interesting but not a cause for action. Rasmussen said a stiffer strategy was in order. Along with "You're not failing your Pap test but it might be failing you," the other print ad features five women looking quite solemn, with this statement: "If you're a gambling woman, then getting just a Pap test is fine." The TV ad shows the women talking about HPV, wondering why they didn't know it causes cancer. "Everyone we know should know," one says.
While Rasmussen said the ads are not designed to stoke fear, several physicians disagreed.
"I think that's a little alarmist, to be honest," said Sandra E. Brooks, director of gynecologic oncology at the University of Maryland Medical Center in Baltimore.
"This is very blatant," said Angell, who is also a physician at Harvard Medical School. "It's trying to frighten women. But it's not surprising. That's what these ads try to do. I think this is just doing it in a more extreme way."
Alan G. Waxman, the director of obstetrics and gynecology at the University of New Mexico, also thinks the ads distort the accuracy of the Pap test. Waxman is the author of an American College of Obstetrics and Gynecology 2003 practice bulletin that said using the Pap test, which looks for abnormal and possibly cancerous cells, along with the HPV test, which looks for the virus that can cause the cancer, is "appropriate" for women over 30 years old.
"I was very careful. I didn't explicitly recommend it," said Waxman, who like Brooks only uses the test after abnormal Pap smears. "It's another way of screening for cervical cancer. But to recommend it would give it higher priority over the Pap alone, and I don't think the data is there to support that."
He offered published data showing that 45 months after having a negative Pap test, the assurance of not having cancer is 99.47 percent. When the Pap test was done with the HPV test, the assurance rose to 99.84 percent.
"So it definitely offers more protection, but by a very small margin over just doing Pap smears alone," Waxman said.
Fleischman bristled at Waxman's analysis.
"If you are in that 0.37 percent of women missed by the current system, you're not going to feel like that's an insignificant number," Fleischman said. "With 50 to 60 million Pap smears done every year, you'd be missing hundreds of thousands of women who could get cancer. I wouldn't want to be one of those women."
Fleischman continued: "The Pap is far from perfect. When you put it together with our HPV test, you approach perfection. We're trying to save women's lives. Using our test is the only way to eliminate this cancer."
Even still, Waxman and Brooks said they are hesitant to use the test as a primary screening tool because of this quandary: A negative Pap smear combined with a positive HPV test. Since most women carry HPV at some point without developing cancer, a positive HPV test can cause unneeded worry.
But Brooks and Waxman also said that if both tests are negative, the patient does not need to be screened again for three years, a clear advantage over the Pap test, which still requires yearly follow-ups.
And in the end, despite their criticisms of the ads, the physicians said they would probably order the test if their patients ask for it.
"My guess is that growth of this test will be driven by patient requests, rather than by providers feeling this is a substantially better test," Waxman said. "Doctors like to please their patients. There was a time when we didn't advertise in medicine but times have changed. It's a much bigger business now and if these ads work, more power to Digene."