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Pap smear test in the gynecologist's office.
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Vaginal Pap test at the Gynecologist's Office
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For most women under the age of 65, a visit to the gynecologist often has an unpleasant need: a Pap test to check the risk of cervical cancer
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There is a simpler way to screen for the risk of cervical cancer by directly testing the human papillomavirus (HPV), which causes 99% of cervical cancer of the uterine cervix. A study published in JAMA Tuesday suggests that the method might be better for women aged 30 and older.
The FDA approved the first HPV test in 2014, which tests vaginal and cervical secretions (which can be collected with a buffer) for presence
The new study, called the HPV FOCAL trial, compared the test of HPV for traditional cervical smear screening in 19,000 Canadian women over a four-year period. He adds to a body of research suggesting that the HPV test might be more accurate.
"In our world, this study is going to be a good deal, in a good way," says Dr. Kathleen Schmeler, an oncologist gynecologist at the MD Anderson Cancer Center at the University of Texas.
According to Schmeler, in the United States, it is difficult to justify the replacement of Pap smear with the HPV test because there has been no direct comparison up to now .
The question is not resolved. Some remain skeptical about using HPV testing alone, and co-testing, or the use of HPV testing and a Pap test, remains the norm.
Screening for cervical cancer is essential as nearly 13,000 women are diagnosed with cervical cancer More than 4,000 women die from it, even with screening and treatment.
The US Preventive Services Task Force's current guidelines recommend that women between the ages of 30 and 65 perform a Pap test every three years or every five years if an HPV test is performed at the same time.
Autumn by the USPSTF recommended one or the other – a Pap test or an HPV test – instead of co-testing for women 30 years and older. The organization has not yet released any definitive guidelines. This new study could prove important for deciding practice guidelines.
At the beginning of the HPV FOCAL trial, some women received an HPV test and some had a Pap smear; those who were negative in the Pap smear received a second smear after two years. Both groups were retested using both methods after four years.
None of the methods was foolproof. The last series of cotesting revealed additional abnormal cells in some women who initially had a negative result in both groups. Women who had passed the Pap test were originally more than twice as likely to have abnormal cells. Of the women who tested negative on the HPV test, only 22 women had abnormal cells (grade 3 or worse), while 52 women had abnormal cells in the vaginal smear group
. We detect precancerous lesions earlier, "says lead author Dr. Gina Ogilvie. "If women have a negative HPV test, they are significantly less likely to have a precancerous lesion four years later, which means we can extend the screening time."
Ogilvie, a professor of medicine at the University of British Columbia, shows that the actual value of the co-test actually comes from the HPV test, not the Pap test.
Studies like this could lead to a change in the guidelines, according to Dr. Chris Zahn, vice president of practice at the American College of Obstetricians and Gynecologists.
"This study adds evidence to those who evaluated the use of HPV as a primary screening modality, and the results support the use of HPV only as a primary screen," he writes in an email.
Although guidelines change for women over the age of 30, Pap smear testing is still important for women aged 21 to 29 years. According to Schmeler, they can not count on the HPV test, because almost all members of this age group contract HPV and, in many cases, it pulls alone. If the virus persists until the thirties, it is there that intervene the problems.
"If you have tested everyone for HPV in their twenties, they will almost all be positive, but this whole intervention will not be necessary," she says.
Getting away from the co-test may not be a good idea, according to Mark Spitzer, an OB-GYN and past president of the American Society for Colposcopy and Cervical Pathology. He wrote in an email that this new study actually shows the weak but significant benefit of the co-test. He quotes the small group of women who discovered abnormal cells at the end of the study period.
"In the United States, the co-test is currently the gold standard recommended, and neither the doctors nor their patients should be I am willing to give up the extra benefit of the Pap test and the test of Papillomavirus screening, "he says
. Diane Harper, a professor of medicine who studies HPV at the University of Michigan, argues that the study was "extraordinarily well done" and that dropping the co-test could result in a decrease in false positives
. for [co-testing] is that you get a slight improvement in sensitivity, "says Harper. "But your rate of false positives is increasing: up to 30% of people [who] are falsely positive."
Women who have a positive Pap test usually get a colposcopy, which is an even closer look at the cervix, vagina and vulva for signs of disease.
A false positive could mean going through a biopsy during a colposcopy. Biopsies come with risks like bleeding, infections and pelvic pain, according to the Mayo Clinic. Harper says false positives lead to unnecessary costs and fears for patients.
"It's a lot of women who are unnecessarily worried," she says.
Women can get a clear result from a simple HPV test and those who receive a negative result will be in able to trust these results for many years. she says.
"It's really amazing, there's no other test that gives us such a level of comfort for this period of time for cancer," Harper says.
Cervical smears depend on the human eye for results, she says, and it is best to detect problems at the molecular level.
Although the guidelines change for women over 30, the Pap test 21-29 years. According to Schmeler, they can not count on the HPV test, because almost all members of this age group contract HPV and, in many cases, it pulls alone. If the virus persists until the thirties, it is there that intervene the problems.
"If you have tested everyone for HPV in their twenties, they will almost all be positive, but this whole intervention will not be necessary," she says.
According to Dr. Carol Mangione, a member of the USPSTF Task Force and Professor of Medicine at the University of California at Los Angeles, screening, no matter what, is what save lives. She says the test method comes second to be sure that all women, especially high-prevalence groups like black and Hispanic women, are able to get the tests they need.
"Most cases of cervical cancer occur in women who have not been routinely screened or who have been screened but who do not have access to treatment appropriate, "she says. "When we think about cervical cancer screening, we want to think about it in the context of how we put this test in the hands of all women."
Sara Kiley Watson's twitter is @sarakileywatson.
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