HPV test should replace Pap test for cervical cancer screening, study suggests

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

This study selected a sample of women in British Columbia, placing 9,457 women in a control group to receive liquid-based cytology (LBC) testing and 9,552 in an intervention group to receive HPV testing.

Tests that look for the human papillomavirus, or HPV, are more accurate than traditional Pap tests at detecting the precancerous lesions that lead to cervical cancer, according to a Canadian study of more than 19,000 women.

According to American College of Obstetricians and Gynecologists (ACOG) women aged 21 to 29 years should have a Pap test every three years while women aged between 30 to 65 years should have a Pap test along with a HPV test every five years or a Pap test every three years. 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.

"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. A study published in JAMA Tuesday suggests that method might be preferable for women aged 30 and over. The Pap smear has been around for 50 years, so co-testing remains a viable option, Wright said. 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. 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.

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.

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The study found that nearly six women in 1,000 that came negative with only Pap test had pre-cancerous lesions.

In most provinces, Pap tests are recommended every three years.

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).

The human papillomavirus (HPV) causes 99 percent of all cases of cervical cancer, according to the National Cancer Institute. They recommend further studies to help researchers understand long-term clinical outcomes and cost-effectiveness across both tests.

This trial showed that screening with HPV testing leads to earlier diagnosis of cervical pre-cancer and picks up cases that Pap testing missed, he said.

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The researchers compared people who had the HPV test, the Pap smear and both, and analyzed their impact over four years.

Half of the women in the study were randomized to get the HPV test and half to the standard Pap smear screening alone.

One caution about the study findings, says Dr. Carol Mangione, a USPSTF task force member and UCLA professor of medicine, is that screening - either kind - is what saves lives. Further, Ogilvie added, "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".

But Mark Spitzer, a gynecologist in New Hyde Park, New York, and past president of the American Society for Colposcopy and Cervical Pathology, disagreed. Those who tested negative with a Pap smear returned two years later and, if they tested negative again, another two years later. He called use of the HPV test only a "reasonable strategy" but noted that the test's strength - its sensitivity - could result in more positive results and more testing.

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