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HPV test should replace Pap test for cervical cancer screening, study suggests
05 July 2018, 10:04 | Silvia Roy
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In the U.S., using both the Pap smear and the HPV test, or co-testing, is the gold standard recommended by the U.S. Preventative Services Task Force. 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.
According to American College of Obstetricians and Gynecologists (ACOG) women aged 21 to 29 years should have a Pap test every three years while women aged between 30 to 65 years should have a Pap test along with a HPV test every five years or a Pap test every three years.
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".
Numerous medical groups have said that before moving to HPV testing only, they needed to see clinical trial results - such as the kind provided by the new head-to-head study - to determine which test, over time, was better at detecting the precancerous changes. At the end of the four years the women were tested using both tests.
"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.
In an accompanying editorial, L. Stewart Massad, MD, of the Washington University School of Medicine in St. Louis, argued that cytology testing does not significantly improve the accuracy of HPV testing, but it does increase costs and false-positive results. According to the article, the researchers surveyed 5080 women treated for early-stage breast cancer by 377 surgeons in Georgia and Los Angeles between 2013 and 2015.
Pap smears involve scraping cells from the cervix and examining them for cancerous changes, also known as "cytology" testing. The vaccine is given to teens and young adults, but generations of women are still at risk of cervical cancer because HPV eventually infects most people at some point.
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.
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.
In most provinces, Pap tests are recommended every three years. In both the groups, the final co-testing discovered more abnormal cells within some of the women who initially tested negative.
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After four years, the women who got HPV tests were less likely to have serious changes that can lead to cervical cancer, a diagnosis of cervical intraepithelial neoplasia 2 or 3 (CIN2 and CIN3), Ogilvie's team found. According to the same trial study group, the test finds 94.6 percent of suspected cervical cancer cases. The two groups were again tested with both the methods post of 4 years.
"This is one study", he said.
That kind of early detection is the hallmark of cervical cancer prevention, because health-care providers can take action to treat precancerous cells before they become cancer.
In addition to finding more precancers in the initial screening, women who had the HPV test had a "significantly lower likelihood" of having precancer in the cervix when they exited the study four years later. "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". Instead of a physician scraping the cells from the back of a woman's cervix before visually inspecting them for signs of abnormality, an HPV test analyzes cells found in vaginal and cervical secretions.
Its replacement? The human papillomavirus test. "The real benefit of co-testing is with the HPV test", she said.
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Medical students learn how to insert a speculum, part of the process of performing a Pap smear.
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