Sunday, 22 July, 2018


Study Finds HPV Test Viable Alternative to Pap Smear

For Women Over 30, There May Be A Better Choice Than The Pap Smear HPV test may be better than Pap smears to detect early cervical cancer: Study
Patty Aguilar | 05 July, 2018, 22:43

This study selected a sample of women in British Columbia, placing 9,457 women in a control group to receive liquid-based cytology (LBC) testing and 9,552 in an intervention group to receive HPV testing. Almost all cervical cancer cases are linked to HPV infection, and HPV testing detected pre-cancers earlier and more accurately than the Pap test among the 19,000 women in the Canadian study.

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.

"These results are exciting as they will help us move towards simpler and more effective screening, which along with the preventive HPV vaccine will help significantly decrease cervical cancer deaths for women all over the world", said Dr. Kathleen Schmeler, an expert in women's cancers at The University of Texas MD Anderson Cancer Center.

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. She also added that the current study is next step showing that by using only HPV testing in a screening scenario, four years later, women who received HPV testing were less likely to develop precancerous lesions. At the four-year mark, all women were tested using both methods.

"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.

Several experts predicted the results would spur efforts to entirely replace the Pap test with the HPV test. A study published in JAMA Tuesday suggests that method might be preferable for women aged 30 and over. The researchers also noted concerns over lower CIN2+ specificity with HPV testing, leading to higher screen positive rates and therefore more colonoscopies and biopsies, which could cause unintended harms for women and increased costs if the tests prove unnecessary.

Smear tests look for changes to cells of the cervix, while HPV testing looks for the presence of the virus.

About 13,240 new cases of invasive cervical cancer will be diagnosed in the United States in 2018, according to the American Cancer Society. They also found that the HPV test was a better predictor of women who would be cancer free in future compared to Pap test. Of the women who tested negative on the HPV test only 22 women showed abnormal cells (grade 3 or worse), while from the Pap smear group, 52 women ended up with abnormal cells.

After follow up, researchers determined HPV testing detected significantly more CIN3+ cases in the first round of screening than did the Pap test (P .001). They can't rely on HPV testing, Schmeler says, because nearly everyone in that age group will contract HPV and in many cases it goes away on its own. The Canadian task force does note that HPV testing may be recommended once more research is available.

At the beginning of this HPV FOCAL trial, half of the women obtained HPV testing and the other half received Pap smear. Some women might not even realize that they are being tested for HPV. 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. They checked on almost 19,000 women and found that detecting HPV was more predictive of early stage cervical cancer than the routine Pap tests.

Its replacement? The human papillomavirus test.

The team of researchers included 19,009 women over the age of 25 years and screened them using either Pap test alone or HPV testing alone. Those who tested negative with a Pap smear returned two years later and, if they tested negative again, another two years later.

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

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