Published: Sat, July 07, 2018
Medicine | By Earnest Bishop

Primary HPV Testing: Fewer Cases of Cervical Precancer vs Pap Test

Primary HPV Testing: Fewer Cases of Cervical Precancer vs Pap Test

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. 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 HPV test, which has not traditionally been offered to all women, might be simpler and more accurate. "With a negative HPV, we know testing can be done much less frequently", Ogilvie says. 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.

A visit to the gynecologist for cervical cancer test is often an unpleasant necessity for women under 65.

The HPV infection is the most common sexually transmitted infection and is usually eliminated by the immune system within a year or two. 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. Women with negative Pap smear results received a second Pap smear after 24 months.

"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 says.

Yet almost a third of women aged 24 to 64 - 1.2 million - missed their cervical smear test in 2016/17, with just 72 per cent of those who qualify being tested, down from 75.7 per cent in 2011. Despite the widespread use of cervical cancer screening with a Pap smear, it was estimated that approximately 12,820 women in the United States would develop, and 4210 would die, from cervical cancer in 2017. This would mean that a positive HPV screen could represent a false-positive cancer screen, as not all HPV infections progress to a cancer diagnosis - some of them clear on their own. Additionally, they could not be diagnosed with invasive cervical cancer or have received a total hysterectomy. The Pap smear has been around for 50 years, so co-testing remains a viable option, Wright said.

The researchers reported that there were fewer cases of precancer in the HPV test group, compared with the Pap smear group. After four years, all the women also got tested with both types of test.

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Pap smears involve scraping cells from the cervix and examining them for cancerous changes, also known as "cytology" testing.

They also cautioned that more work needs to be done to assess the economic consequences of changing the screening model.

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. 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. Infection with HPV types targeted by the vaccine has declined by almost two-thirds among teenage girls since HPV vaccination was recommended in the United States, according to a study that also found that there was a decrease in HPV infections among women 20 to 24. He wrote in an email that this new study actually shows the small but significant benefit of co-testing.

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

Of note, the Canadian Task Force on Preventative Health Care differs from the US task force - it recommends Pap smear screening every three years between ages 30 and 69, citing weak evidence for screening women ages 25 to 29.

Women should discuss the risks and benefits of each test with their doctor, Wright said. Partly because of that, he said, "we're a long way away from replacing the Pap smear".

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