A study from Canada found that an initial test for human papilloma virus (HPV), which causes nearly all cases of cervical cancer, led to the discovery of more pre-cancerous lesions than were found with conventional smear tests. The women who actually received Pap smear showed twice more chances of having abnormal cells. Lead author of the study and professor at the University of British Columbia, Dr Gina Ogilvie, said, "There has been a significant body of evidence that shows that by including HPV testing - as co-testing with cytology - we could improve detection of precancerous lesions of the cervix".
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.
Despite the widespread screening programs, it was estimated that 12,820 women would be diagnosed with cervical cancer and approximately 4,210 would die from cervical cancer in 2017.
Because the HPV vaccine that is recommended for adolescents is still limited in its use, testing for the presence of the HPV virus, in general, will continue to be a crucial part of cervical cancer prevention. Organisations that develop cancer screening guidelines are wrestling with whether to recommend replacing co-testing with primary HPV testing as the optimal screening strategy. 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 has been around for 50 years, so co-testing remains a viable option, Wright said.
A test for HPV detects precancerous changes of the cervix earlier and more accurately than the Pap smear, according to a large clinical trial published Tuesday.
The authors stated that one of the concerns related to primary HPV screening is lower CIN2+ specificity, "leading to higher screen positive rates and the resulting need for more colposcopies and biopsies". Where it is hard to apply HPV tests over pap smear for USA as there hasn't been head to head comparison until now. However, it looks like neither test was completely certain, as abnormalities were found in women from both groups who tested negative previously. Two years later, the ones that tested negative after the Pap smear had another test of the same type.
"The real benefit of co-testing is with the HPV test."
The new study, called the HPV FOCAL trial, compared the HPV test to traditional Pap smear screening among 19,000 Canadian women over four years.
At present, as per the screening guidelines from the draft issued last fall by USPSTF, the tests supposed to be taken for every 5 years for HPV tests and 3 years for pap smear. "If women have a negative HPV test, they are significantly less likely to have a precancerous lesion four years later, meaning we can extend screening time". 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? "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". From the participants, 9,552 women were screened using HPV test and those who were negative for the test came back after four years for a check if they had a pre-cancerous or cancerous lesion.
Human papillomavirus (HPV) is a DNA virus from the papillomavirus family.
"It's really fantastic, there's no other test that gives us this level of reassurance for that period of time for a cancer", Harper says.
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