Published: Sun, July 08, 2018
Medical | By Garry George

HPV test should replace Pap test for cervical cancer screening, study suggests

HPV test should replace Pap test for cervical cancer screening, study suggests

The study results showed that the human papillomavirus test is more sensitive than the widely used but often flawed method of performing a regular Pap smear, and several experts are predicting a strong push to replace Pap smears with simple HPV testing.

USA guidelines call for both HPV and Pap tests, but studies have shown that the real benefit comes from the HPV test, she added.

Researchers, led by the University of British Columbia, found that significantly more women showed signs of abnormal cells in the first round of HPV testing compared to the conventional smear tests, despite similar questionnaire responses.

According to The Washington Post, a large clinical "gold standard" trial published on Tuesday revealed that the test for HPV can detect precancerous changes of the cervix earlier and more accurately than the Pap smear.

The researchers compared people who had the HPV test, the Pap smear and both, and analyzed their impact over four years.

"Although cervical screening guidelines from a number of organizations have recommended primary HPV testing based on the natural history of cervical cancer, cross-sectional studies, studies where HPV-based screening was part of a screening group, or where studies ultimately evolved into primary HPV evaluations, none of these studies were designed specifically to examine HPV testing as the primary screening modality", Ogilvie reported. They recommend further studies to help researchers understand long-term clinical outcomes and cost-effectiveness across both tests. Two years later, the ones that tested negative after the Pap smear had another test of the same type.

Kathleen Schmeler, a gynecological oncologist at MD Anderson Cancer Center who was not involved in the study, was enthused about the new results. "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.

Even the most ideal tests can also be limited by the fact that not all women are receiving regular and timely screening.

Women in the HPV group who screened negative returned at 48 months, while women in the cytology group who were negative at 24 months returned at 48 months, and both groups received co-testing at the 48 month exit.

"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.

Pap smears rely on the human eye to get results, says Dr. Diane Harper, a professor of medicine who researches HPV at the University of MI, "and it's far preferable to detect problems on a molecular level". 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. However, it looks like neither test was completely certain, as abnormalities were found in women from both groups who tested negative previously. More than 4,000 women die from it, even with screening and treatment. They focused mainly on moderate or severe changes to cervical cells (pre-cancerous changes) that could lead to cervical cancer. This new study could prove important in deciding practice guidelines.

Its replacement? The human papillomavirus test.

Dr. Carol Mangione, a USPSTF task force member and UCLA professor of medicine says the method of testing comes second to being sure that all women, especially high-prevalence groups like black and Hispanic women, are able to get the testing they need. He cites the small group of women who had abnormal cells discovered through a Pap smear at the end of the study period. Partly because of that, he said, "we're a long way away from replacing the Pap smear".

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