HPV Test Beats Pap

A new study found that the HPV test was better than the Pap smear in detecting precancerous changes that can lead to cervical cancer

When it comes to cervical cancer screening, most women receive a cytology-based Papanicolau (Pap) smear, where cells are scraped from the back of the cervix.

For women between the ages of 30 and 65 who are at risk of contracting human papillomavirus, a promising test might be an alternative to the dreaded Pap smear.

More women were referred for colposcopy after HPV tests at the start of the study: 57 per 1,000 women compared with 30.8 per 1,000 women after smear tests - but the reverse was true at 48 months. He said that physicians will have to make the choice between HPV testing and co-testing based on cost-effectiveness studies and their own discretion, while continuing to improve outreach for underserved and inadequately screened women to combat such high rates of cervical cancer.

It was funded by the Canadian Institutes of Health Research and published in the peer-reviewed Journal of the American Medical Association on an open-access basis, so it is free to read online.

Specifically, the task force is recommending either screening every three years with a Pap test alone or every five years with an HPV test alone for women aged 29 to 65. "The HPV virus is the cause of 99 per cent of the cervical cancers".

Massad has consulted with malpractice attorneys in cases alleging missed cervical cancer but declared he had no relevant financial relationships with industry.

Lead author Dr. Gina Ogilvie is in favor of a shift from Pap smears to HPV testing.

Limitations to the study include that the women sampled were highly-educated and not geographically diverse.

Pap smears rely on the human eye to get results, she says, and it's far preferable to detect problems on a molecular level. More than 4,000 women die from it, even with screening and treatment. According to the researchers, roughly one-third of surgeons said they often or always delayed surgery to obtain genetic testing.

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"This information will help inform future cervical cancer screening guidelines and continue to decrease deaths from this preventable disease", added Schmeler, who was not involved in the study. The researchers observed that women who were HPV-negative at baseline were significantly less likely to have CIN2+ or CIN3+ at 48 months compared with those who had negative Pap smear results at baseline.

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 study is titled "Effect of Screening With Primary Cervical HPV Testing vs Cytology Testing on High-grade Cervical Intraepithelial Neoplasia at 48 Months - The HPV FOCAL Randomized Clinical Trial".

This study suggests this change would lead to more cases of pre-cancerous lesions being found than under the current system.

Many women who have HPV (usually acquired via sexual contact) eliminate it from their bodies within a year or two. "Women who have a negative HPV test are significantly less likely to have a precancerous lesion 4 years down the road than those who had a negative Pap". This new study could prove important in deciding on practice guidelines.

But Mark Spitzer, a gynecologist in New Hyde Park, New York, and past president of the American Society for Colposcopy and Cervical Pathology, disagreed. Then four years later, both groups were tested using both methods, in order to see the results. They found that the HPV test had several benefits over the Pap smear.

"We really can't answer the question around whether co-testing is better than either alone". He called use of the HPV test only a "reasonable strategy" but noted that the test's strength - its sensitivity - could result in more positive results and more testing.

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.

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

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