Medicine

HPV test tops Pap smear at detecting precancerous cervical changes, study says

HPV test tops Pap smear at detecting precancerous cervical changes, study says

Approved by the FDA in 2014, the HPV test is a relatively new alternative to Pap smears.

The randomized, controlled study - the kind of trial considered the "gold standard" of research - showed that the human papillomavirus test is more sensitive than the Pap smear, a widely used test that has been a standard part of women's preventive health care for decades but has drawbacks.

But HPV testing is thought to have a lower specificity for CIN2+ than cytology screening, which could result in more colposcopies and biopsies being performed - some of which may be unnecessary, says the author of a related but separate JAMA editorial. 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 findings were published July 3 in the Journal of the American Medical Association. While neither method was foolproof, the study found that women who originally had the Pap smear were more than twice as likely to have abnormal cells, the article reported. At the end of the four years the women were tested using both tests.

Geographically, North America dominates the Pap smear and HPV testing market followed by Europe. According to the article, the researchers surveyed 5080 women treated for early-stage breast cancer by 377 surgeons in Georgia and Los Angeles between 2013 and 2015. The Pap smear worked, he said, only because women were tested often and because cervical cancer grows slowly. The vaccine is given to teens and young adults, but generations of women are still at risk of cervical cancer because HPV eventually infects most people at some point.

About 13,240 new cases of invasive cervical cancer will be diagnosed in the United States in 2018, according to the American Cancer Society.

However, because all women who were HPV test negative in the study also received a Pap smear, additional cases of early cancer were detected.

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"Whether it's co-testing or choosing one test over another, it's really important to think about the system in which cervical cancer screening is introduced, and that women are called back and followed-up for an abnormal test, whether it be a Pap smear or an HPV test", Ogilvie said. "This trial. found primary HPV testing detected significantly more CIN3+ and CIN2+ cases in the first round and significantly reduced CIN3+ and CIN2+ rates 48 months later". It adds to a body of research suggesting that HPV testing might be more accurate.

At the beginning of this HPV FOCAL trial, half of the women obtained HPV testing and the other half received Pap smear.

Dr. Carol Mangione, a USPSTF task force member and UCLA professor of medicine 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. Some women might not even realize that they are being tested for HPV.

One limitation of the study was that it was done in a specific area of Canada and the findings may not be generalized to other populations.

The new study will probably "help push that along", said Wright of NewYork-Presbyterian/Columbia University Medical Center. That's what some experts believe after a new study found that the HPV test detects precancerous cervical changes earlier and more accurately. "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 said. The two groups were again tested with both the methods post of 4 years.

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

"It's really wonderful, there's no other test that gives us this level of reassurance for that period of time for a cancer", Harper says. Partly because of that, he said, "we're a long way away from replacing the Pap smear".


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