As NPR reports, it's been hard to justify replacing the Pap smear with the HPV test because, until now, there hasn't been a head-to-head comparison. The HPV test identified significantly more precancerous lesions earlier, and four years after the women were initially screened, they received both an HPV test and a Pap test.
Most medical groups have recommended that women in the United States get both the HPV test and the Pap smear, a practice called "co-testing", and many medical doctors are urging this practice continue, like Dr. Dena Grayson, who brought it up on Twitter.
"Here in B.C. we have an organized screening program, but we still miss early cervical cancer in women with apparently normal Pap smears", lead author Dr. Gina Ogilvie, a family physician and senior public health scientist at the BCCDC, told ABC News.
These researchers reported this study shows that the real value of co-testing actually comes from the HPV test, not the Pap smear. They noted that women who had a negative HPV test were more likely to be cancer free for the next four years compared to those who got a negative Pap test. "The HPV virus is the cause of 99 per cent of the cervical cancers".
Of note, the Canadian Task Force on Preventative Health Care differs from the US task force - it recommends Pap smear screening every three years between ages 30 and 69, citing weak evidence for screening women ages 25 to 29. Some of them used the regular Pap smear screening, while others used the HPV testing. The HPV test found nearly 60 percent more abnormal cells that could potentially become cancerous during the initial screening than the Pap test, bolstering previous research that showed that HPV testing was superior.
'This can mean that women may need to be screened less frequently but have more accurate results.' There are about 3,000 cases of cervical cancer in the United Kingdom every year, leading to around 850 deaths.
Women with positive HPV or smear tests had their samples immediately analysed using the other test and then had a colposcopy if results showed both HPV and changes to cells. A draft recommendation from the U.S. Preventive Services Task Force in 2017 recommended cytology testing to screen for cervical cancer every 3 years and HPV testing every 5 years for women ages 30 to 65.
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Though the researchers also determined that adding cytology testing after a positive HPV screen detected very few new events, it wasn't totally fool-proof: by virtue of the trial design, women who were found to be HPV-negative also received cytology screening at 48 months - and an additional three grade 2 lesions were found among those participants.
'Research shows HPV primary screening will save an estimated 400 cervical cancer diagnoses every year so any delays to roll out could result in diagnoses which could have been prevented.
Testing for HPV is a less intrusive method for cancer screening.
In an accompanying editorial, L. Stewart Massad, MD, of the Washington University School of Medicine in St. Louis, argued that cytology testing does not significantly improve the accuracy of HPV testing, but it does increase costs and false-positive results. They recommend that women between 21 and 65 should have a Pap smear every three years, but that women aged 30 to 65 may choose to have both the Pap smear and HPV testing together every five years.
Most cases are preventable with screening the best way of catching it before it develops. This new study could prove important in deciding practice guidelines. He cites the small group of women who had abnormal cells discovered through a Pap smear at the end of the study period.
Its replacement? The human papillomavirus test.
Medical students learn how to insert a speculum, part of the process of performing a Pap smear.