Monday, 24 September, 2018

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

For Women Over 30, There May Be A Better Choice Than The Pap Smear Study: HPV Test Beats Pap
Gustavo Carr | 05 July, 2018, 22:05

This new study, called the HPV FOCAL trial, compared the results of a randomized clinical trial comparing Pap smears with the use of HPV tests. Cervical cancer is one of the simplest gynecologic tumors to control, for which two screening tests can help diagnose the disease at its very earlier stage. one is the standard Pap smear, while another is testing for human papillomavirus infection, or HPV. If the guidelines change, and people over 30 switch to the HPV test, doctors will still most likely recommend that sexually active patients younger than 30 stick with the Pap smear.

The lead author of the study, Dr. Gina Ogilvie, said in a statement, "What our study shows is that by using HPV testing, we detect precancerous lesions earlier".

After the first round of the study at 12 months, women who received HPV testing received follow-up colposcopies at a higher rate (57%) than those in the control group (30.8%).

In the first round of screening at the start of the study, more cases of CIN3+ were found in women who had HPV tests (7 per 1,000 women) than women who had smear tests (4.4 per 1,000 women). A new study suggests a simpler method for screening for cervical cancer risk in women aged 30 and over, NPR reported.

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. According to the study, this method is recommended for the women aged thirty and above. The Pap smear worked, he said, only because women were tested often and because cervical cancer grows slowly.

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. For women under 25, the Task Force suggests use of Pap test alone because many of them are infected with HPV.

Cervical cancer screening is essential because almost 13,000 women in the US are diagnosed with cervical cancer annually.

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

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The Task force states that for women aged between 29 and 65 HPV tests alone every five years can be the only screening test.

"In the USA, co-testing is now the recommended gold standard, and neither doctors nor their patients should be willing to give up the added benefit you get from screening with a Pap test and HPV test together", he says. "This has been building for decades", he said, adding that the Pap smear is "crude and inaccurate" while the HPV test is much more precise, operates on the molecular level and can provide information on the specific type of HPV causing the problem.

But, neither testing method was found to be foolproof. After four years, almost six women in 1,000 who had Pap tests had pre-cancerous lesions, compared with just two in 1,000 women who had HPV tests alone.

But Mark Spitzer, a gynecologist in New Hyde Park, New York, and past president of the American Society for Colposcopy and Cervical Pathology, disagreed. In 2017, the researchers running the study reported that there were significantly more cases of precancerous lesions detected early in the trial among the women in the HPV-tested group, compared with the Pap cytology group. As a result, the study's results are likely an underestimate, as underserved women were not included, although they may face the highest risk of developing cervical cancer, the authors said.

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.

"It's really awesome, there's no other test that gives us this level of reassurance for that period of time for a cancer", Harper says.

In fact, one study showed that grade 3 cervical lesions progress to invasive cervical cancer 50% of the time or less.