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HPV test or Pap test for cervical cancer screening?

CTCA

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If you’re between ages 30 and 65, you may have had the HPV test along with a Pap test as part of routine screening. For almost 60 years, the Pap test has been the preferred way to detect early pre-cancerous changes that can lead to cervical cancer, but can the newer HPV test do a better job?

Researchers have been studying the question for more than 15 years and their results support the idea that the HPV test could be the primary cervical cancer screening tool. The most recent study, published last month in the Journal of the National Cancer Institute, found that women with a negative HPV test had half the risk of developing cervical cancer within three years as did women with a negative Pap test.

HPV, or human papillomavirus, is the most common sexually transmitted infection and is responsible for virtually all cases of cervical cancer. There are more than 100 types of HPV but just two, HPV 16 and HPV 18, cause about 70 percent of all cases. An HPV DNA test approved by the FDA in April looks for the presence of those two types.

For the recent study, researchers at the National Cancer Institute analyzed data from more than 1 million California women, ages 30 to 64, who had HPV and Pap tests between 2003 and 2012. Among the group, 405 women were diagnosed with cervical cancer within five years of joining the study. Of those women, 76 had a negative HPV test at enrollment, 129 had a negative Pap test and 50 had negative results from both tests, known as co-testing.

The HPV test more accurately predicted the cases of cervical cancer than the Pap test did. Among the women who had co-testing, the HPV test was the main predictor of cancer. Experts, though, do not recommend using the HPV test alone as a primary screening tool.

In 2012, the U.S. Preventive Services Task Force updated cervical cancer screening guidelines. It recommends the Pap test every three years for women between ages 21 and 65, and the Pap test and HPV test every five years for women ages 30 to 65 who want extend the time between testing.

The HPV test is not recommended for women younger than 30 because infections in younger women may be more likely to clear up on their own. An HPV test could result in unnecessary follow-up exams, biopsies and treatments.

While the HPV and Pap tests both involve taking a sample from the cervix, the HPV test mixes the cervical sample with re-agents before a machine reads it. The sample from a Pap test is sent to a laboratory, where a pathologist looks for abnormalities under a microscope. Advocates of the HPV test say its results are more objective because they are not based on individual interpretation.

The HPV test, though, is not expected to replace the Pap test anytime soon. The Pap test has been credited with the dramatic decrease in cervical cancer deaths in the U.S. and doctors may be slow to abandon it, especially without new guidelines from the federal government or professional societies. It also is typically less expensive than the HPV test, which typically costs $80-$100 compared with the $20-$40 cost of the Pap test.

Dr. Giuseppe Del Priore, National Director of Gynecologic Oncology at our hospitals, says, “The real breakthrough will come when HPV testing cost and complexity comes down so that greater access can be realized by those women most likely to suffer.”

Learn about the risk factors for cervical cancer.

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