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

Grant Boone
July 7, 2018

A new study called HPV Focal trial tests HPV tests with pap smear over 19000 canadian women over 4 years and found HPV tests are more accurate.

Lead researcher Dr. Gina Ogilvie, a professor in the School of Population and Public Health at the University of British Columbia, in Vancouver explained that cervical cancer screening should be performed for all women who belong to the reproductive or childbearing age.

The HPV test, which has not traditionally been offered to all women, might be simpler and more accurate.

At present, the NHS screening programme for cervical cancer starts with a smear test. Women whose smear test results show possible low-grade or borderline changes to cells will have the sample tested for HPV. If the HPV test is negative, it gives more assurance that women will not develop precancer in the next four years.

The initial HPV test that examines cervical and vaginal secretions for the existence of HPV, was approved by the FDA in the year 2014.

The HPV infection is the most common sexually transmitted infection and is usually eliminated by the immune system within a year or two.

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". In both the groups, the final co-testing discovered more abnormal cells within some of the women who initially tested negative.

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Most cervical cancers are caused by a particular strains of the Human papillomavirus, or HPV.

According to the American College of Obstetricians and Gynecologists, women aged 21 to 29 should have a Pap test alone every three years.

"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. 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. The Pap smear has been around for 50 years, so co-testing remains a viable option, Wright said. As a result, the study's results are likely an underestimate, as underserved women were not included, although they may face the highest risk of developing cervical cancer, the authors said. However, it looks like neither test was completely certain, as abnormalities were found in women from both groups who tested negative previously. Consistent with prior studies, more cases of abnormal cells in the cervix, known as cervical intraepithelial neoplasia (CIN), grade 3 or worse (CIN3+), were detected in the intervention group compared with the control group in the first round of screening.

The Canadian researchers explain that nearly all cases of cervical cancer are associated with a HPV infection.

"This supports the small, but significant benefit of co-testing". 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.

In most provinces, Pap tests are recommended every three years. 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. So while the HPV test is more sensitive of a test, it isn't flawless and missed some women with early signs of cervical cancer. Partly because of that, he said, "we're a long way away from replacing the Pap smear".

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