The HPV test is at the height of Pap smear to detect precancerous cervical changes, study shows

A test for HPV detects precancerous changes in the cervix earlier and more precisely than the Pap smear, according to a large clinical trial released Tuesday.

The randomized controlled study – the kind of trial considered the gold standard for research – showed that the human papillomavirus test is more sensitive than the Pap test, a widely used test that has been part of women's preventive care for decades, but has several disadvantages.

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" on people 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 year 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.

About 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, 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 breast cancer. vaginal smear. a practice called "co-test". Now, armed with new and previous studies, some experts say that the Pap test should be abandoned. But others do not agree, saying that the Pap test can detect a small number of abnormal cell cases that could be missed by the HPV test and that the co-test should continue.

Many medical groups said this before moving on 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 towards getting 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? 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, the 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 than in those in the study group. Pap cytology group

. of the study 48 months after the registration of women and the 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 small 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 test to HPV alone.

"It's been decades," he said, adding that cervical-uterine smear is "gross and imprecise". HPV testing is much more accurate, works at the molecular level and can provide information about the specific type of HPV that is causing the problem. The cervical smear only worked because women were often tested and the cancer of the cervix was developing slowly.

Most medical groups, which the American Cancer Society and the American College of Obstetricians and Gynecologists, recommend to women Pap smears are performed every five years between ages 30 and 65, 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 that would self-dispel. .

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 the infections last longer, they can cause not only cancer of the cervix, but also cancer of the anus and the back of the throat as well as penile cancer in the body. man

. against HPV; 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, according to a study that also revealed The United States Preventive Services Task Force, an independent group examining evidence of the effectiveness of preventive services, currently recommends the "co-test Advocated by 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

. said Wright, of the New York-Presbyterian / Columbia University Medical Center. He called the use of the HPV test a "reasonable strategy," but noted that the strength of the test – its sensitivity – could lead to more positive results and more tests.

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