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A new study found that the HPV test was better than the Pap test to detect precancerous changes that could lead to cancer of the cervix of the uterus. (iStock)
An HPV test detects precancerous changes in the uterine cervix sooner and more accurately than the Pap test, according to a large clinical trial released on Tuesday.
The Randomized, Controlled Study – the kind of trial considered the "gold standard" of research – showed that the human papillomavirus test is more sensitive than the smear, a widely used test that has been part of women's preventive care for decades, but has several disadvantages.
predicted that the results would stimulate efforts to completely replace the Pap test with the HPV test. "This is an important study," said Jason Wright, a gynecologist oncologist at New York-Presbyterian / Columbia University Medical Center who did not participate in the study. "It shows that the HPV test alone provides a high degree of accuracy" over who might be at risk for cervical cancer.
HPV is the most common sexually transmitted infection and is usually eliminated by the immune system in one or two years. 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.
Approximately 13,240 new cases of invasive cervical cancer will be diagnosed in the United States in 2018, according to the American Cancer Society. In recent years, while experts were learning more about the role of HPV in cervical cancer, most medical groups have recommended that women in the United States get both the test HPV and Pap test. a practice called "co-test". Now, armed with new and previous studies, 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 that before switching to HPV -testing only, they needed to see clinical trial results – like the kind provided by the new one-to-one study – to determine which test, over time, was better at detecting 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, NY, 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? The ten-year study, which appeared in JAMA, involved about 19,000 women who were placed in two groups: one using the HPV test to screen for cervical cancer. and the other using a type of Pap test called cytology. In 2017, researchers who conducted the study reported that there were significantly more cases of precancerous lesions detected at the beginning of the trial in women in the HPV-tested group compared to the group of Pap cytology.
Tuesday's report detailed the results of the study's release 48 months after women's registration and first screening. For these end results, both groups were tested using both the HPV test and Pap smear
The researchers reported that there were fewer cases of pre-cancer in the HPV test group compared to 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 real benefit of the co-test is with the HPV test," she said.
The paper noted that the addition of the HPV test to the Pap test had uncovered 25 lesions that would not have been detected by the Pap test alone. By adding the Pap test to the HPV group, three more lesions were found
Spitzer said that these three cases "support the low but significant benefit of the co-test."
Mark Schiffman of the National Cancer Institute, who has the study confirmed that it is important to go from Pap smear to HPV alone. "This has been built for decades," he said, adding that the Pap test is "crude and inaccurate" while the HPV test is much more accurate, works at the molecular level and can provide information about the specific type of HPV that causes the problem.The cervical smear only worked because women were often tested and cervical cancer was developing slowly
Most medical groups, including lympha The American Cancer Society and the American College of Obstetricians and Gynecologists recommend that at-risk women undergo both HPV testing and vaginal smears every five years between the ages of 30 and 65 years. Three years is an acceptable alternative. It is advisable for women in their twenties to have Pap smears, and not an HPV test, because the virus is so common that most would be tested positive for infections that would likely go away by themselves. .
About 80 million people infected with HPV, but most never develop any health problems because most infections go away on their own, 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 and penile cancer in humans [19659017] That is why doctors strongly recommend immunization of children and young adults. against HPV; a vaccine was approved by the Food and Drug Administration in 2006. Infection with HPV-targeted types of vaccine decreased by nearly two-thirds in teenage girls, since vaccination against HPV was recommended to the states According to a study
The Task Force on Preventive Services of the United States, an independent group that examines the evidence of the effectiveness of preventive services, currently recommends the "co-test" advocated by D & D. Other groups. But last fall, he issued a draft recommendation proposing that women undergo either an HPV test every five years, or a Pap test every three years, but a final recommendation was not made. published
. Wright of New York-Presbyterian / Columbia University Medical Center. He called the use of the HPV test only a "reasonable strategy", but noted that the strength of the test – its sensitivity – could result in more positive results and more tests. Partly because of this, he said, "We are far from replacing the Pap smear."
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