HPV better than Pap smear for picking up precancerous changes cervix

HPV test is better than Pap smear at detecting precancerous cervical changes study says

An exam room at the National Institutes of Health in Bethesda Md

The HPV test identified significantly more precancerous lesions earlier, and four years after the women were initially screened, they received both an HPV test and a Pap test.

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 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". The randomized, controlled study-the Washington Post calls it the "gold standard" of research-looked at 19,000 women over a period of 10 years.

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.

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".

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Because all the women in the study who testing negative for HPV were given Pap smears at the end of the study, the results can't determine how one test alone compares to co-testing.

Most cervical cancers are caused by a particular strains of the Human papillomavirus, or HPV. According to Kathleen Schmeler, MD, gynecologic oncologist, University of Texas MD Anderson Cancer Center, even if guidelines do change for women age 30 and older, the Pap smear is still important for women age 21 to 29.

Schmeler says that in the USA, it has been hard to justify replacing the Pap smear with the HPV test because there has not been a head-to-head comparison until now. Despite the widespread use of cervical cancer screening with a Pap smear, it was estimated that approximately 12,820 women in the United States would develop, and 4210 would die, from cervical cancer in 2017. "But we don't want to miss people who have potentially high-grade precancerous disease and they don't know it and they could go on to be at higher risk for developing invasive cervical cancer". Some are still skeptical of relying on HPV testing alone, and co-testing, or using both the HPV test and a Pap smear, is still the standard.

But four years later, the referral rates were 49.2 per cent in the HPV group compared with 70.5 percent in the other, suggesting earlier detection of the virus. Women in their 20s are advised to get Pap smears, not HPV tests, because the virus is so common that most would test positive for infections that would most likely clear up on their own. 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. But last fall, it issued a draft recommendation proposing that women undergo either HPV testing every five years or Pap smears every three years, but a final recommendation has not been released.

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"This supports the small, but significant benefit of co-testing". Rising geriatric population will also add fuel this market, as they will further demand for more cancer assays and tests and hence will contribute towards the growth of this market in future.

This means that women may need to be screened less frequently but have more accurate results.

They also cautioned that more work needs to be done to assess the economic consequences of changing the screening model.

Medical students learn how to insert a speculum, part of the process of performing a Pap smear.

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