Co-Testing for Cervical Cancer is Best, But Not Perfect

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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.

Canadian researchers led by Professor Dr. Gina Ogilvie (the School of Population and Public Health - University of British Columbia, Vancouver) found out that most of the cervical cancer cases are associated with HPV infection. A total of 19,009 women were randomized to receive either HPV testing (intervention group) or a Pap smear (control group).

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).

After checking on nearly 19,000 women, they realized that detecting HPV was a more accurate way to detect early-stage cervical cancer compared to the routine Pap tests. Cervical cells for both the Pap and HPV tests can be collected at the same time, during a pelvic exam. He said that although the study confirmed previous research showing that the HPV test is more sensitive than the Pap test, it didn't answer a critical question: Is the HPV test alone better than the HPV test and the Pap smear together, as is current practice?

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

According to the American College of Obstetricians and Gynecologists, women aged 21 to 29 should have a Pap test alone every three 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 fact, at the conclusion of the study, all HPV-negative women were tested with the Pap smear, which led to finding additional cases of pre-cancerous lesions". She says the method of testing comes second to being sure that all women, especially high prevalence groups like black and hispanic women, are able to get the testing they need.

The virus is now known to be the main cause of cervical cancer.

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The researchers said their results show that "primary HPV testing detects cervical neoplasia earlier and more accurately than cytology", adding that it "detected significantly more CIN3+ and CIN2+ cases in the first round and significantly reduced CIN3+ and CIN2+ rates 48 months later". However, the U.S. Preventive Services Task Force, which creates guidelines for the diseases people should be screened for and when, still recommends Pap smears every three years for most women with uteruses ages 30 to 65, NPR reports.

Many women who have HPV (usually acquired via sexual contact) eliminate it from their bodies within a year or two.

That kind of early detection is the hallmark of cervical cancer prevention, because health-care providers can take action to treat precancerous cells before they become cancer. Still, it seems that more accurate outcome came from the HPV test than from the Pap smear, which could influence decisions in the future. The other group was tested using the Pap test and returned after two years and four years for rechecks.

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

They also cautioned that more work needs to be done to assess the economic consequences of changing the screening model. 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. Luckily, this study indicates that the HPV test is accurate enough that there are few false positives, in which a test identifies a disease that isn't actually there.

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

Pap smears rely on the human eye to get results, she says, and it's far preferable to detect problems on a molecular level. Partly because of that, he said, "we're a long way away from replacing the Pap smear".

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