Published: Thu, July 05, 2018
Health Care | By Cedric Leonard

HPV Test More Accurate than Pap In Screening for Cervical Cancer

HPV Test More Accurate than Pap In Screening for Cervical Cancer

A simpler way to test for cervical cancer is the HPV test, which is performed by directly testing for the human papillomavirus, or HPV, which causes 99 percent of cervical cancer.

As a part of this recent study known as HPV FOCAL trial, the HPV test was compared to the conventional Pap smear examination among nineteen thousand women in Canada over 4 years.

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. That's because cases of worrisome cellular changes already had been detected and dealt with after the women were first screened, said lead author Gina Ogilvie, a physician and public health researcher at the University of British Columbia.

The study, published in the Journal of the American Medical Association, adds to a growing body of evidence that HPV tests may be superior to Pap smears. Those in the Pap group who tested negative returned two years later for another and, if they tested negative again, returned at the end of the four-year study.

"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.

Several experts predicted the results would spur efforts to entirely replace the Pap test with the HPV test.

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Limitations to the study include that the women sampled were highly-educated and not geographically diverse. They could also get a Pap test every three years. 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. However, it looks like neither test was completely certain, as abnormalities were found in women from both groups who tested negative previously.

According to the American College of Obstetricians and Gynecologists, women aged 21 to 29 should have a Pap test alone every three years. The Canadian task force does note that HPV testing may be recommended once more research is available.

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". If the HPV test is negative, it gives more assurance that women will not develop precancer in the next four years. "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".

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. Now, armed with the new study and previous ones, some experts say the Pap smear should be dropped. Additionally, they could not be diagnosed with invasive cervical cancer or have received a total hysterectomy.

"If you tested everyone for HPV in their twenties, they are nearly all going to be positive, but there's going to be all of this intervention that's not needed", she says.

The new study will probably "help push that along", said Wright of NewYork-Presbyterian/Columbia University Medical Center. "The real benefit of co-testing is with the HPV test", she said. 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.

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