In the last five decades, the Pap smear test has been used to screen for early signs of cervical cancer.
Might women over 30 soon be saying goodbye to the Pap smear?
Lead researcher Dr. Gina Ogilvie, a professor in the School of Population and Public Health at the University of British Columbia, in Vancouver explained that cervical cancer screening should be performed for all women who belong to the reproductive or childbearing age.
Numerous medical groups have said that before moving to HPV testing only, they needed to see clinical trial results - such as the kind provided by the new head-to-head study - to determine which test, over time, was better at detecting the precancerous changes. At the end of the four-year study, the women were tested with both tests.
"Most cases of cervical cancer happen in women who have not been regularly screened, or who have been screened, but don't have access to appropriate treatment", she says. They detect only around 55 percent of true cases, according to a study by the Canadian Cervical Cancer Screening Trial Study Group, and requires a special process using a liquid medium that takes several days.
Pap smears involve scraping cells from the cervix and examining them for cancerous changes, also known as "cytology" testing.
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Although there could be increased costs associated with sending more patients for additional tests and monitoring after HPV detection, those may be offset by the fact that people may not need to have the initial screening as often, she said. Women in their 20s are advised to get Pap smears, not HPV tests, because the virus is so common that most would test positive for infections that would most likely clear up on their own. A total of 19,009 women were randomized to receive either HPV testing (intervention group) or a Pap smear (control group).
Women who had a negative HPV test at the start of the study were much less likely to develop CIN3+ within 48 months than women who had a negative smear test at the start of the study. Of the women who tested negative on the HPV test only 22 women showed abnormal cells (grade 3 or worse), while from the Pap smear group, 52 women ended up with abnormal cells. The US Preventive Services Task Force now recommends a Pap smear every three years or co-testing every five years for women age 30 and up, but it is considering changing that recommendation to just one test or the other, and this study could speed things along, NPR reports. However, human papillomavirus (HPV)-based testing may be a more accurate way of testing for cervical cancer, new study results suggest. They recommend further studies to help researchers understand long-term clinical outcomes and cost-effectiveness across both tests. According to the same trial study group, the test finds 94.6 percent of suspected cervical cancer cases.
Many women who have HPV (usually acquired via sexual contact) eliminate it from their bodies within a year or two. "The ASCCP [American Society for Colposcopy and Cervical Pathology] pointed out that just doing the HPV testing would miss some people, and so they advocated for co-testing". These conditions can be treated before they progress to cervical cancer.
For women under 25, the Pap test is still the standard because many young women are infected with HPV, Ogilvie said. He called use of the HPV test only a "reasonable strategy" but noted that the test's strength - its sensitivity - could result in more positive results and more testing. In 2017, the researchers running the study reported that there were significantly more cases of precancerous lesions detected early in the trial among the women in the HPV-tested group, compared with the Pap cytology group.
Women in the HPV group who screened negative returned at 48 months, while women in the cytology group who were negative at 24 months returned at 48 months, and both groups received co-testing at the 48 month exit.
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