Published: Thu, July 05, 2018
Medicine | By Douglas Stevenson

HPV test better than Pap when screening for cervical cancer

HPV test better than Pap when screening for cervical cancer

For most women under 65, a visit to the gynecologist often includes an unpleasant necessity: a Pap smear to check for cervical cancer risk.

The lead author of the study, Dr. Gina Ogilvie, said in a statement, "What our study shows is that by using HPV testing, we detect precancerous lesions earlier".

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. The control group had the traditional Pap test for their initial screening, while the test group had primary HPV screening - a test that looked for more than a dozen specific types of HPV most likely to cause precancerous lesions in the cervix. Quite often the smear test can be unpleasant for women, but luckily there is an easier way to screen for cervical cancer risk.

Massad has consulted with malpractice attorneys in cases alleging missed cervical cancer but declared he had no relevant financial relationships with industry. She explained that according to the new draft guideline from the U.S. Preventive Services Task Force, HPV test may soon replace the Pap test. 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 rely on the human eye to get results, she says, and it's far preferable to detect problems on a molecular level.

A test for HPV detects precancerous changes of the cervix earlier and more accurately than the Pap smear, according to a large clinical trial published Tuesday.

"But we will gradually move to more HPV testing for primary screening", he said. However, other experts now say the Pap smear should be dropped in favor of regular HPV testing. By adding the Pap test to the HPV group, an additional three lesions were found.

In most provinces, Pap tests are recommended every three years. Previous research has indicated that HPV testing alone or combined with a Pap smear is linked to increased detection of precancerous lesions in the first screening round, followed by a subsequent reduction in precancerous lesions. 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. 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.

The women who took part in the study were aged between 25 and 65, had not had a smear test in the past 12 months, were not pregnant, and had no history of cervical cancer or pre-cancerous changes in the past 5 years.

But Mark Spitzer, a gynecologist in New Hyde Park, New York, and past president of the American Society for Colposcopy and Cervical Pathology, disagreed.

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.

Women with positive HPV or smear tests had their samples immediately analysed using the other test and then had a colposcopy if results showed both HPV and changes to cells. The HPV test is more popular in Canada, and the trial used data from 19,000 British Columbians who consented to having their anonymized data collected and compared. Additionally, they could not be diagnosed with invasive cervical cancer or have received a total hysterectomy.

Leslie Massad, MD, a professor of obstetrics and gynecology at Washington University in St. Louis, wrote an editorial to accompany the study and agrees with its conclusion that HPV tests perform better than Pap tests.

"It's really awesome, there's no other test that gives us this level of reassurance for that period of time for a cancer", Harper says. But there were still no final guidelines issued on this and that's why the new study might be important in helping with the decision. Partly because of that, he said, "we're a long way away from replacing the Pap smear".

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