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According to a new study, the Pap test used for decades as a standard in screening for cervical cancer in Canadian women should be replaced by a test that detects types of human papillomavirus (HPV) at high risk.
The virus is badociated with the vast majority of cancers of the cervix of the uterus.
A clinical trial conducted in British Columbia and published in the Journal of the American Medical Association (JAMA) randomly divided about 19,000 women into two groups. The control group presented the traditional Pap test for initial screening, while the test group had primary HPV testing – a test that looked for more than a dozen specific types of HPV that could cause precancerous cervical lesions. of the uterus.
The HPV test found nearly 60% more precancers – or potentially cancerous abnormal cells – during initial screening than the Pap test, said Dr. Dirk van Niekerk, co-author of the study and medical pathologist. Head of Cervical Cancer Screening Program in British Columbia Cancer Agency.
This type of early detection is the hallmark of cervical cancer prevention because health professionals can take steps to treat precancerous cells before they become cancerous. Depending on the "grade", or how advanced they are, they may simply require monitoring (because in younger patients the cells sometimes repeat themselves alone)
Alternatively, they may be removed with laser treatment or electric. loop of wire – a procedure known as "LEEP."
"The precancerous stage is essentially 100 percent curable," van Niekerk said. "They usually take up to 10 years to progress to cancers, but the fact is that if you do not find them, and you do not know how long they've been there, there's a chance that they're going to get there. they can progress to the invasion "
" Better detection earlier "
That they undergo a Pap test or HPV test, the patient experience is the same in their office doctor or nurse practitioner.Women undergo the same physical examination when their cervix is buffered for cells.The difference occurs when this sample is sent to the laboratory for badysis.
The Pap test identifies abnormalities in cervical cells, signaling health care providers to take a closer look to see if they are precancerous, then take appropriate action.
The HPV test is based on DNA and researches Specific strains of the virus in the echan
In addition to finding more precancers in the initial screening, women who had the HPV test had a "significantly lower likelihood" of having a precancer in the cervix when they left the clinic. Study four years later
. tested positive for precancerous or abnormal cells at the beginning received additional tests and the necessary treatment, van Niekerk said.
Dr. Nancy Durand, a gynecologist at the Sunnybrook Health Sciences Center in Toronto who did not participate in the study, said that "the HPV test should replace Pap tests as a standard of care" . This will happen in the years to come.
The trial showed that the HPV test can "better detect earlier" people at risk "that we really need to follow more closely," said Durand.
"Some of them will not require treatment, but some will not, but we do not want to miss those who have precancerous high-grade disease and do not know it." 39, there may be increased costs badociated with sending more patients for additional testing and surveillance after HPV detection, these can be offset by the fact that people do not need to undergo initial screening As often, she said.
In most provinces, Pap tests are recommended every three years.The HPV test may only be required every five years years, says Durand, "because it's such a precise test."
Because health care is a provincial responsibility, it is up to the provinces and territories to decide to adopt the HPV test for Pap tests for uterine cervix cancer screening.
Dan s an e-mailed statement to CBC News, Dr. Jennifer Blake, CEO of the Society of Obstetricians and Gynecologists of Canada, said, "Our HPV guideline is still under development. uterine cervix screening programs. "
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