HPV Test More Accurate than Pap In Screening for Cervical Cancer
05 Julio, 2018, 22:04 | Author: Earnest Bishop
As NPR reports, it's been hard to justify replacing the Pap smear with the HPV test because, until now, there hasn't been a head-to-head comparison. Cervical cancer is one of the simplest gynecologic tumors to control, for which two screening tests can help diagnose the disease at its very earlier stage. one is the standard Pap smear, while another is testing for human papillomavirus infection, or HPV. Generally speaking, women who had the Pap smear were more than twice as likely to have abnormal cells; HPV testing resulted in 22 cases whereas the Pap smear had 52 women with abnormal cells.
Suboptimal specificity of the HPV test is still a limiting factor for widespread adoption of the test as a cancer screening tool, write the authors of the editorial, "especially among populations of young women who often carry HPV infections that regress without oncogenic outcome". It was published this month in the Journal of the American Medical Association.
Current screening guidelines from U.S. Preventive Services Task Force recommend women aged 30 to 65 go in every three years for a Pap test or every five years if a HPV test is done at the same time. At the end of the four years the women were tested using both tests.
Several experts predicted the results would spur efforts to entirely replace the Pap test with the HPV test.
Pap smears involve scraping cells from the cervix and examining them for cancerous changes, also known as "cytology" testing. 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. So while the HPV test is more sensitive of a test, it isn't ideal and missed some women with early signs of cervical cancer. A total of 19,009 women were randomized to receive either HPV testing (intervention group) or a Pap smear (control group).
Women who had a negative HPV test at the start of the study were much less likely to develop CIN3+ within 48 months than women who had a negative smear test at the start of the study. But last fall, it issued a draft recommendation proposing that women undergo either HPV testing every five years or Pap smears every three years, but a final recommendation has not been released.
"The real benefit of co-testing is with the HPV test."
The Pap test, used for over 50 years to spot the early signs of cervical cancer, may soon become a thing of the past, new research suggests.
At the beginning of this HPV FOCAL trial, half of the women obtained HPV testing and the other half received Pap smear. According to the same trial study group, the test finds 94.6 percent of suspected cervical cancer cases. If the HPV test is negative, it gives more assurance that women will not develop precancer in the next four years.
One caution about the study findings, says Dr. Carol Mangione, a USPSTF task force member and UCLA professor of medicine, is that screening - either kind - is what saves lives. "If you tested everyone for HPV in their 20s, they are nearly all going to be positive, but there's going to be all of this intervention that's not needed", she 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.
Its replacement? The human papillomavirus test. "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". The other group was tested using the Pap test and returned after two years and four years for rechecks.
"It's really unbelievable, there's no other test that gives us this level of reassurance for that period of time for a cancer", Harper says.
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