HPV test better than Pap when screening for cervical cancer

HPV test better than Pap when screening for cervical cancer

The other group was screened using Pap cytology, the liquid-based test that has largely replaced the conventional Pap smear in the US. Pap smear tests and HPV tests are designed in such a way that they help in early detection of precancerous and cancerous processes of cervical cancers so as to avoid contracting those cancers.

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.

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. 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.

"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.

Massad has consulted with malpractice attorneys in cases alleging missed cervical cancer but declared he had no relevant financial relationships with industry.

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

Dr. Gina Suzanne Ogilvie of the Women's Hospital and Health Center in Vancouver and colleagues set up a comparison study. 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. This is why most women still choose both of them. However, other experts now say the Pap smear should be dropped in favor of regular HPV testing.

Schmeler often works in Latin America where, in countries like El Salvador, cervical cancer is one of the most common cancers in women primarily due to poor screening programs.

However, because all women who were HPV test negative in the study also received a Pap smear, additional cases of early cancer were detected. In both the groups, the final co-testing discovered more abnormal cells within some of the women who initially tested negative.

However, we do know that detecting cervical cancer earlier makes it easier to treat, so a test that can do that is likely to be welcome. The Canadian task force does note that HPV testing may be recommended once more research is available. But according to the study, cumulative CIN2+ incidence was similar in the two groups after the end of the trial at 72 months.

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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. After four years, almost six women in 1,000 who had Pap tests had pre-cancerous lesions, compared with just two in 1,000 women who had HPV tests alone.

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. "These results have demonstrated that primary HPV testing detects cervical neoplasia earlier and more accurately than cytology", they wrote.

But Mark Spitzer, a gynecologist in New Hyde Park, New York, and past president of the American Society for Colposcopy and Cervical Pathology, disagreed. "The real benefit of co-testing is with the HPV test", she said.

Human papillomavirus (HPV) is a DNA virus from the papillomavirus family.

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