A visit to the gynecologist for cervical cancer test is often an unpleasant necessity for women under 65. The test involves letting a doctor or nurse scrape cells from the back of the cervix, which are visually inspected for signs of abnormality.

Image: LM of cervical smear revealing HPV infection

A simpler way to test for cervical cancer is the HPV test, which is performed by directly testing for the human papillomavirus, or HPV, which causes 99 percent of cervical cancer. A study published in JAMA Tuesday, suggests that method might be preferable for women age 30 and over.

However, women under 30 need to have the pap smear, as their tests with HPV usually end up being positive.

In 2014 FDA approved the first HPV test. Cervical cancer screening is essential because nearly 13,000 women in the U.S. are diagnosed with cervical cancer annually. More than 4,000 women die from it, even with screening and treatment.

A new study called HPV Focal trial tests HPV tests with pap smear over 19000 canadian women over 4 years and found HPV tests are more accurate. Where it is hard to apply HPV tests over pap smear for US as there hasn’t been head to head comparison until now.

“In our world this study is going to be a pretty big deal, in a good way,” says Dr. Kathleen Schmeler, a gynecologic oncologist at the University of Texas MD Anderson Cancer Center.

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. And only either of the tests are to be taken, but not both.

Neither method was foolproof. The final round of co-testing found additional abnormal cells in some women who originally tested negative in both groups. Women who originally had the Pap smear were more than twice as likely to have abnormal cells. Of the women who tested negative on the HPV test only 22 women showed abnormal cells (grade 3 or worse), while from the Pap smear group, 52 women ended up with abnormal cells.

“What our study shows is that by using HPV testing, we detect precancerous lesions earlier,” says lead author Dr. Gina Ogilvie. “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.”

“In the U.S., co-testing is currently 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,” says Mark Spitzer

“The whole reason for [co-testing] is that you get a slight improvement in sensitivity,” Harper says. “But your false positive rate blows up. It’s up to 30 percent of people [who] are falsely positive.”

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 Michigan, “and it’s far preferable to detect problems on a molecular level.”

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.

“Most cases of cervical cancer happen in women who have not been regularly screened, or who have been screened, but don’t have access to appropriate treatment,” she says. “When we think about cervical cancer screening, we want to think about it in the framework of how do we get this test in the hands of all women?”


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