Better HPV test preventing cervical cancer than Pap smear

Better HPV test preventing cervical cancer than Pap smear

Testing for cancer-related human papillomavirus (HPV), which causes 99.7 percent of cervical cancer, outperformed the effectiveness of Pap smears in women over the age of 30.

The study finds two key advantages to the HPV test, says Gina Ogilvie, MD, a professor of public health at the University of British Columbia, Vancouver. Some of them used the regular Pap smear screening, while others used the HPV testing.

"Whether it's co-testing or choosing one test over another, it's really important to think about the system in which cervical cancer screening is introduced, and that women are called back and followed-up for an abnormal test, whether it be a Pap smear or an HPV test", Ogilvie said. In 2017, the researchers running the study reported that there were significantly more cases of precancerous lesions detected early in the trial among the women in the HPV-tested group, compared with the Pap cytology group. Cervical cells for both the Pap and HPV tests can be collected at the same time, during a pelvic exam. Most sexually active adults contract HPV at some point, but it is usually cleared without problems. He said that although the study confirmed previous research showing that the HPV test is more sensitive than the Pap test, it didn't answer a critical question: Is the HPV test alone better than the HPV test and the Pap smear together, as is current practice?

However, because all women who were HPV test negative in the study also received a Pap smear, additional cases of early cancer were detected. "The ASCCP [American Society for Colposcopy and Cervical Pathology] pointed out that just doing the HPV testing would miss some people, and so they advocated for co-testing". However, it looks like neither test was completely certain, as abnormalities were found in women from both groups who tested negative previously. Consistent with prior studies, more cases of abnormal cells in the cervix, known as cervical intraepithelial neoplasia (CIN), grade 3 or worse (CIN3+), were detected in the intervention group compared with the control group in the first round of screening.

"This is one study", he said. It adds to a body of research suggesting that HPV testing might be more accurate.

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"Most cases of cervical cancer happen in women who have not been regularly screened, or who have been screened, but don't have access to appropriate treatment", she says.

"Multiple randomized trials have shown that primary HPV screening linked to subsequent identification and treatment of cervical precancer is more effective than Pap testing in reducing the incidence of cervical cancer and precancer, at the cost of lower specificity and more false-negative subsequent colposcopic assessments", Massad wrote. Because the HPV test was more likely to pick up on pre-cancerous cervical lesions earlier in the study, these women were less likely to develop cervical cancer. Those who tested negative with a Pap smear returned two years later and, if they tested negative again, another two years later. Increasing awareness among the global population about the benefits associated with these type of tests such as pre cancer detection have also led to the increased number of procedures for testing cervical cancers across the globe. "Even if we could magically vaccinate 100 percent today, it would take 30 years for them to reach the age of 40, and to see a meaningful decrease in cervical cancer", Spitzer added.

The new study will probably "help push that along", said Wright of NewYork-Presbyterian/Columbia University Medical Center. They could also get a Pap test every three years.

Its replacement? The human papillomavirus test. "This trial. found primary HPV testing detected significantly more CIN3+ and CIN2+ cases in the first round and significantly reduced CIN3+ and CIN2+ rates 48 months later".

Medical students learn how to insert a speculum, part of the process of performing a Pap smear.

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