HPV Test Beats Pap

Enlarge this image

In the last five decades, the Pap smear test has been used to screen for early signs of cervical cancer. For women under 25, the Task Force suggests use of Pap test alone because many of them are infected with HPV.

"In the US, co-testing is now the recommended gold standard, and neither doctors nor their patients should be willing to give up the added benefit you get from screening with a Pap test and HPV test together", he says.

The HPV test also seemed better at predicting who'd stay cancer-free, the investigators found. Women whose HPV test showed they didn't have the infection were less apt to develop a pre-cancerous lesion over the next four years, compared to women who'd gotten the Pap test alone.

The National Cancer Institute's Mark Schiffman, who has done extensive research on HPV, said the study confirmed that it's important to move from the Pap smear to the HPV test alone. Most sexually active adults contract HPV at some point, but it is usually cleared without problems.

The findings were published July 3 in the Journal of the American Medical Association. Overall, approximately 35% of patients had an elevated risk of carrying a genetic mutation, but just 27% of women in the study received genetic testing, the article reported.

Pap smear tests are also referred as Pap test or smear test or cervical smear test, in which Pap smear is prepared by collecting cells from outer cervix opening of the uterus and endocervix. Nearly each type of cervical cancers is caused due to the infection by one of the 12 types of oncogenic human papilloma viruses (HPV).

Cervical cancer screening is essential because almost 13,000 women in the US are diagnosed with cervical cancer annually.

The HPV test, which was first approved in 2014, uses cervical and vaginal secretions to check for the presence of HPV. They focused mainly on moderate or severe changes to cervical cells (pre-cancerous changes) that could lead to cervical cancer. The Pap smear has been around for 50 years, so co-testing remains a viable option, Wright said.

Most cases are preventable with screening the best way of catching it before it develops.

Pap smears involve scraping cells from the cervix and examining them for cancerous changes, also known as "cytology" testing. Infection with HPV types targeted by the vaccine has declined by almost two-thirds among teenage girls since HPV vaccination was recommended in the United States, according to a study that also found that there was a decrease in HPV infections among women 20 to 24. A total of 19,009 women were randomized to receive either HPV testing (intervention group) or a Pap smear (control group). The final round of co-testing found additional abnormal cells in some women who originally tested negative in both groups.

Of note, the Canadian Task Force on Preventative Health Care differs from the USA task force - it recommends Pap smear screening every three years between ages 30 and 69, citing weak evidence for screening women ages 25 to 29.

Spitzer said those three cases support the "small but significant benefit of co-testing". Similarly 9,457 women were tested using Pap test and they too returned at 24 and 48 months for a repeat check up to see if they had cervical cancer. Partly because of that, he said, "we're a long way away from replacing the Pap smear". Luckily, this study indicates that the HPV test is accurate enough that there are few false positives, in which a test identifies a disease that isn't actually there. But because the HPV test is more sensitive to these abnormal cells, it could result in more women with positive rates resulting in a need for more colposcopies and biopsies, something the authors say could have unintended harm and increases in health care costs.



Other news