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FRIDAY, November 2, 2018 (HealthDay News) – Human papillomavirus (HPV) testing has become the standard of care for cervical cancer screening. But now, Canadian researchers say it may be useless for women 55 and older who test negative.
The HPV DNA-based test is extremely accurate in the detection of 14 high-risk virus strains responsible for the majority of cervical cancers.
In the new study, researchers first collected data on more than 200,000 women living in British Columbia. They then created a mathematical model that estimated lifetime risk of cervical cancer in older women, who had not all been vaccinated against HPV.
The result: a single negative HPV DNA test at age 55 suggested that a woman presents a very low risk (less than 1%) of cervical cancer, and ongoing screening with this type test would have little benefit, according to the study. .
However, the researchers said that regular screening with the traditional Pap test – and cheaper – up to 75 years, can still prevent some cervical cancers. But even then, benefits would decrease with age.
"Our results suggest that for countries that use the HPV test as part of their screening, it may be possible to stop screening earlier than we currently do, provided that women undergo a negative HPV test" said Talia Malagon, author of the study, from McGill University in Montreal.
But an obstetrician / gynecologist said that it was too early to make firm recommendations.
"I encourage readers to use this data to justify stopping uterine cervix screening after the age of 55," said Dr. Adi Davidov, in charge of Ob / Gyn care at Staten Island University Hospital in New York.
"First, this study uses mathematical modeling, which may not be accurate," he said. "In addition, many patients are already missing their annual gynecology visit due to new recommendations for less frequent cervical cancer screening.If women stop seeing their gynecologist at age 55, I am afraid that Other serious diseases are not diagnosed. "
The new results were published on November 1 in Lancet Oncology newspaper.
Currently, most recommendations indicate that screening for cervical cancer – using the Pap test or the HPV DNA test – can be stopped after the age of 65 to 69 years. However, there is no high quality evidence to support this recommendation. researchers said.
"Cervical cancers are caused by oncogenic infections [cancer-causing] HPV types, "Malagon said in a press release.For decades, doctors have turned to the Pap test" to detect precancerous lesions caused by HPV, which can then be treated before cancer of the cervix the uterus does develop, "she added.
The Pap test has saved thousands of lives, but "it's far from perfect because it does not always detect precancerous lesions that turn into cancer," Malagon said.
"We have known for some time that direct screening for the types of HPV that cause cervical cancer is as effective, if not better, than [the Pap test] for screening in women under 60, "she said.
It is unclear whether an elderly woman with a negative HPV test can safely stop screening, as it happens in some women whose Pap tests become negative.
The new study could help shed light on this issue, said Malagon.
She warned that the study "does not necessarily suggest that all screening should stop at age 55, because the benefits of ongoing screening depend on the type of screening used." For countries that still use [Pap test] screening, screening at a later age should further reduce the risk of cervical cancer, "she noted.
In addition, "our study did not involve any cost-effectiveness analysis, which would be a useful next step to inform policy decisions before an orientation change is contemplated," Malagon said.
Dr. Jill Rabin participates in Northwell Health's women's health programs in New Hyde Park, New York. She described the results as "interesting", but made several reservations.
She explained that factors that may deter "latent" HPV – factors such as stress or certain medical conditions – may be at play for some older women, making HPV testing invaluable.
In addition, a rare but potentially fatal form of cervical cancer, called cervical adenocarcinoma, does not rely on HPV and "will likely not be detected until its later stages if an examination Regular routine is not performed, "noted Rabin.
She also agreed with David that cervical cancer screening has long been a "bridge" to better gynecological care in general.
"What worries me is that if they stop taking the Pap test, they will miss an exam that could help uncover other medical and gynecological issues, such as cancer." breast, uterus, ovary and colon, "said Rabin.
More information
The US National Cancer Institute has more about HPV.
SOURCES: Adi Davidov, MD, acting president of the Ob / Gyn Department of Staten Island University Hospital, New York; Jill Rabin, MD, Co-Director, Ambulatory Care Division, Women's Health Programs – PCAP Services, Northwell Health, New Hyde Park, NY; Lancet Oncology, press release, November 1, 2018
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