The HPV test can better detect cancer than vaginal smears

By Laurie McGinley | Washington Post

An HPV test detects precancerous changes in the uterine cervix sooner and more accurately than Pap smear, according to a large clinical trial released on Tuesday.

The randomized controlled study – the type of test considered standard "research – showed that the human papillomavirus test is more sensitive than the Pap test, a widely used test that is part of Preventive health care of women for decades, but with drawbacks

Several experts predicted that the results would encourage efforts to fully replace the Pap test with the HPV test. "This is an important study," said Jason Wright, a gynecologist oncologist in New York-Presbyterian / Columbia University Medical Center who did not participate in the study. "This proves that the HPV test alone provides a high degree of accuracy" on people likely to have cervical cancer. The uterus.

HPV infection is the most common badually transmitted infection and is usually eliminated by the immune system. two. But when an infection persists, it can cause cellular changes that turn into precancerous lesions and possibly into malignant tumors. Almost all cases of cervical cancer are caused by HPV infections.

About 13,240 new cases of invasive cervical cancer will be diagnosed in the United States in 2018, according to the American Cancer Society. About 4,200 women will die of the disease.

The study supports previous research that showed that HPV testing was superior to Pap tests. In recent years, as experts learned more about the role of HPV in cervical cancer, most medical groups have recommended that American women undergo both HPV testing and bad cancer. Pap smear. With the new study and the previous ones, some experts say that the Pap test should be abandoned. But others disagree, saying that Pap smear can detect a small number of abnormal cell cases that may be missed in the HPV test and that the co-test should continue.

Several medical groups said this before switching to HPV only, they had to see clinical trial results – like those provided by the new one-to-one study – to determine which test, over the course of time, was better able to detect precancerous changes. These conditions can be treated before they reach cancer of the cervix of the uterus.

Kathleen Schmeler, gynecologic oncologist at the MD Anderson Cancer Center who was not involved in the study, was excited about the new findings. "It's fantastic," she said. "What this shows is that you could potentially just do the HPV test and move on to get rid of the Pap test."

But Mark Spitzer, a gynecologist in New Hyde Park, New York, and former president of the American Society for Colposcopy and Cervical Pathology, disagrees. He said that even though the study confirmed that the HPV test was more sensitive than the Pap test, it did not answer a critical question: is the HPV test better than the HPV test and the Pap smear? as is the case now?

In the United States, the conventional Pap test has been largely replaced by a liquid Pap cytology test. Cervical cells for Pap and HPV tests can be collected at the same time, during a pelvic exam. Some women might not even realize that they are being tested for HPV.

The study, published in the Journal of the American Medical Association, brought together approximately 19,000 women divided into two groups: one using the HPV test to screen for cervical cancer, and the other one. other using Pap cytology. In 2017, the researchers who conducted the study reported that there were significantly more cases of precancerous lesions detected at the start of the trial in women in the HPV-tested group, compared to Pap cytology group

. Results of the study 48 months after enrollment and first screening of women. For these end results, both groups were tested using both the HPV test and the Pap test

The researchers reported that there were fewer cases of precancer in the HPV test group, compared Pap smear. This is because cases of disturbing cellular changes have already been detected and treated after screening women, said senior author Gina Ogilvie, a physician and public health researcher at the University of Toronto. British Columbia. The report, funded by the Canadian Institute for Health Research, noted that the addition of the HPV screening test to the Pap test group found 25 lesions were not found by the Pap test alone. By adding the Pap test to the HPV group, three more lesions were found

Spitzer said that all three cases support the "small but significant benefit of the co-test."

Mark Schiffman of the National Cancer Institute, who did a thorough research on HPV, said the study confirmed that it is important to go from pap smear to HPV test alone. "This has been going on for decades," he said , adding that the Pap test is "crude and imprecise" while the HPV test is much more accurate, operates at the molecular level and can provide information on the specific type of HPV causing the problem. "The cervical smear has worked, says it, only because women were often tested and because cervical cancer was developing slowly.

Most medical groups, including the American Cancer Society and the American College of Obstetricians and Gynecologists VP Tests H and Pap smears every five years between 30 and 65 years old, although they say that a single Pap test every three years is an acceptable alternative. It is advisable for women in their twenties to have a Pap test, and not an HPV test, because the virus is so common that most would be tested positive for infections likely to go away.

About 80 million people in the United States infected with HPV, but most never develop any health problems because most infections go away by themselves, according to the Centers for Disease Control and Prevention . But when infections last longer, they can cause not only cancer of the cervix, but also cancer of the anus and throat, as well as penile cancer

. ; a vaccine was approved by the Food and Drug Administration in 2006. Infection with the types of HPV targeted by the vaccine decreased by almost two-thirds among teenagers since HPV vaccination was recommended in the United States. United States, according to a study The US Preventive Services Task Force, an independent group that examines evidence for the effectiveness of preventive services, is currently recommending the "co-test" for cervical cancer signs of the uterus. other groups defend. But last fall, he published a draft recommendation proposing that women undergo an HPV test every five years or a smear every three years, but a final recommendation was not published