HPV test is more effective than Pap test in detecting cervical intraepithelial neoplasia

The results of a new study, published in JAMA indicate that after 48 months, fewer cases of cervical intraepithelial neoplasia (CIN) grade 2 or 3 or worse (CIN2 +, CIN3 +) were found in women who underwent cervical cancer screening with a primary test of human papillomavirus (HPV) compared to women who were screened by cytology alone. These results suggest that the HPV test is able to detect CIN earlier and more precisely than cytology.

Although cervical cancer is one of the most preventable in the United States. About 12,000 women are diagnosed with cervical cancer in the United States each year. Two traditional screening tests – Pap tests (based on cytology) and HPV – are used to detect cervical cell changes as well as HPV. Research has shown that about 99.7% of all cervical cancers are associated with persistent cervical infection with an oncogenic HPV genotype preceding the invasive tumor.

To this end, a team of investigators, led by Gina Suzanne Ogilvie, MD, DrPH, of the Faculty of Medicine at the University of British Columbia, in Vancouver, Canada, led a randomized clinical trial (HPV FOCAL) that included more than 19,000 women recruited between January 2008 and May 2012. Women meeting the study criteria of between 25 and 65 years (mean age 45 years), with no clinical history recent CIN2 +, no history of invasive cancer of the cervix or hysterectomy, no recent PAP (in the past year) and no immunosuppressive treatment Participants were randomized to either a group of Intervention (n = 9552) who received an HPV test, either in a control group (n = 9457) who received a liquid cytology test (LBC). Patients in the HPV group who had negative results after the first round of tests were returned for follow-up after 48 months, while patients tested with LBC who had negative results returned to 24 and then to 48 months.

Control period of 48 months, both groups received the co-test HPV and LBC

The study results indicated that at 48 months, patients in the group of Intervention had significantly lower incidence rates of CIN3 + (2.3 / 1000; 1.5-3.5) compared to patients in the control group (5.5 / 1000, 95% CI: 4 , 2-7,2), with a hazard ratio of 0.42 (95% CI: 0.25-0.69).

Patients in the intervention group reported significantly reduced rates of significant incidence CIN2 + (5.0 / 1000, 95% CI: 3.8-6.7) compared to patients in the group control (10.6 / 1000, 95% CI: 8.7-12.9) at 48 months. The CIN2 + risk ratio was 0.47 (95% CI: 0.34-0.67)

According to the researchers, participants who were initially negative HPV had a significantly lower CIN3 + incidence at 48 than women who were cytologically negative, with a risk ratio of 0.25 (95% CI: 0.13-0.48).

Based on these findings, the investigators concluded that the primary HPV test is capable of detecting cervical neoplasia earlier and more specifically than cytology.

Previous research has shown that HPV testing alone or in combination with cytology is associated with detection of precancerous lesions at the first round of screening; However, until this study there was a shortage of research on the results beyond the initial phase.

"Previous studies have shown that the benefit of HPV and cytology co-testing was based primarily on the contribution of HPV.", According to the study's authors. "Other analyzes modeling the cost-effectiveness of primary HPV screening using the parameters of this study will be performed to evaluate the potential economic effect of the switch to HPV-based screening. "

L. Stewart Massad, MD, Department of Obstetrics and Gynecology at the University of Washington School of Medicine in St. Louis, Missouri, wrote in an editorial on the study that "substantial patient education" prevents the HPV test to become the primary method of screening on cytology and Pap tests. "He went on to explain that women need to be educated about the importance of these tests for sexually transmitted diseases and how , in the absence of treatment nt, HPV can progress to cancer. Although the prevalence of HPV continues to decline since the introduction of a vaccine, tests are still paramount to the health of patients and Dr. Massad believes that the introduction of new screening tools must be combined with efforts to educate and screen women to really make progress in the fight against cervical cancer.

A version of this article was published by MD Mag ® as "The HPV Test Improves the Detection of Cervical Neoplasia Versus Cytology Tests."