Primary HPV Testing: Fewer Cases of Cervical Precancer vs Pap Test

Approved by the FDA in 2014, the HPV test is a relatively new alternative to Pap smears. However, human papillomavirus (HPV)-based testing may be a more accurate way of testing for cervical cancer, new study results suggest.

The confirmation of a positive HPV test appeared to be more predictive of a grade 2 or 3 cervical lesion than cytology screening alone.

Lead researcher Dr. Gina Ogilvie, a professor in the School of Population and Public Health at the University of British Columbia, in Vancouver explained that cervical cancer screening should be performed for all women who belong to the reproductive or childbearing age.

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

The National Cancer Institute's Mark Schiffman, who has done extensive research on HPV, said the study confirmed that it's important to move from the Pap smear to the HPV test alone.

Of note, the Canadian Task Force on Preventative Health Care differs from the US task force - it recommends Pap smear screening every three years between ages 30 and 69, citing weak evidence for screening women ages 25 to 29.

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.

"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.

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

Women in the HPV group who screened negative returned at 48 months, while women in the cytology group who were negative at 24 months returned at 48 months, and both groups received co-testing at the 48 month exit. 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. Dr Kathleen Schmeler, a gynaecologic oncologist at The University of Texas MD Anderson Cancer Center said, "The bottom line is that it could really potentially simplify how we screen women and have it been more effective and not quite as complicated and burdensome - and opens the door for doing just HPV testing which is actually what's now recommended by the World Health Organisation for countries that don't have Pap testing capabilities".

"This information will help inform future cervical cancer screening guidelines and continue to decrease deaths from this preventable disease", added Schmeler, who was not involved in the study. The findings are part of the Human Papillomavirus for Cervical Cancer screening trial, a publicly funded Canadian study.

Pap smear tests are also referred as Pap test or smear test or cervical smear test, in which Pap smear is prepared by collecting cells from outer cervix opening of the uterus and endocervix. The final round of co-testing found additional abnormal cells in some women who originally tested negative in both groups. More than 4,000 women die from it, even with screening and treatment.

It's possible these results were skewed because women received both treatment options at the end of the study.

'We must also not lose sight of the need to improve attendance of this potentially life-saving tests and ensure women can access it'. 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.

However, we do know that detecting cervical cancer earlier makes it easier to treat, so a test that can do that is likely to be welcome.

Vanessa Coleman