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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 a widely used test that has been an integral part of women's preventive care for decades, but has 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. "This shows that HPV testing alone provides a high degree of accuracy" on people likely to develop cervical cancer.
HPV infection is the most common sexually 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 reinforces previous research that has shown that HPV testing is 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 breast cancer. cervical smear. Now, armed with the new study and precedents, 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 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 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 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? Convenient?
In the United States, conventional pap smear has been largely replaced by a liquid-based Pap cytology test. Cervical cells for Pap and HPV tests can be collected at the same time, during a pelvic exam. Some women do not even realize that they are being tested for HPV.
The study, published in the Journal of the American Medical Association, involved about 19,000 women divided into two groups: one using the HPV test. to screen for cervical cancer, and the 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 to the Pap group. 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 about the specific type of HPV causing the problem. "The cervical smear was not working, 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 I & # 39; 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 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 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, according to a study The Task Force on Preventive Services in the United States, an independent group that examines evidence of the effectiveness of preventive services, currently recommends the "co-test" for signs of cervical cancer of the uterus. other groups defend. But last fall, he released 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
. said 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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