Co-Testing for Cervical Cancer is Best, But Not Perfect

05 Juillet, 2018, 22:04 | Auteur: Yves Courtet
  • Speculum

Pap smear tests and HPV tests are designed in such a way that they help in early detection of precancerous and cancerous processes of cervical cancers so as to avoid contracting those cancers. "When we think about cervical cancer screening, we want to think about it in the framework of how do we get this test in the hands of all women?"

The HPV infection is the most common sexually transmitted infection and is usually eliminated by the immune system within a year or two. But when an infection persists, it can cause cellular changes that develop into precancerous lesions and, eventually, malignancies.

The virus is now known to be the main cause of cervical cancer. The study is important in informing screening methods as the American Cancer Society estimates around 13,000 American women will be diagnosed with cervical cancer, and about 4,170 will die from it.

Women who have a positive Pap test, generally get a colposcopy, which is an even closer examination of the cervix, vagina and vulva for signs of disease. He wrote in an email that this new study actually shows the small but significant benefit of co-testing. At the start, half of the women were tested for HPV while the other half had a Pap smear screening.

"This is one study", he said.

For the study, the researchers randomly assigned more than 19,000 women aged 25 and older to either Pap testing alone or HPV testing alone. It was published this month in the Journal of the American Medical Association. These conditions can be treated before they progress to cervical cancer. Gynecologic oncologist Dr. Kathleen Schmeler at the University of Texas MD Anderson Cancer Center, said in a statement, "In our world, this study is going to be a pretty big deal, in a good way".

"That's a lot of women that are unnecessarily anxious", she says.

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In 2014 FDA approved the first HPV test. As a result, the study's results are likely an underestimate, as underserved women were not included, although they may face the highest risk of developing cervical cancer, the authors said.

HPV test will provide accurate results of cervical cancer than Pap smear.

"Although cervical screening guidelines from a number of organizations have recommended primary HPV testing based on the natural history of cervical cancer, cross-sectional studies, studies where HPV-based screening was part of a screening group, or where studies ultimately evolved into primary HPV evaluations, none of these studies were designed specifically to examine HPV testing as the primary screening modality", Ogilvie reported. By 48 months, there were significantly fewer cases of CIN2+ and CIN3+ detected among all age groups in the intervention 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. This type of cancer is mostly caused by the human papillomavirus (HPV), in as much as 99% of all cases.

"What our study shows is that by using HPV testing, we detect precancerous lesions earlier", says lead author Dr. Gina Ogilvie.

"We really can't answer the question around whether co-testing is better than either alone". She says the method of testing comes second to being sure that all women, especially high prevalence groups like black and hispanic women, are able to get the testing they need. The researchers observed that women who were HPV-negative at baseline were significantly less likely to have CIN2+ or CIN3+ at 48 months compared with those who had negative Pap smear results at baseline. The Canadian task force does note that HPV testing may be recommended once more research is available. The Pap smear worked, he said, only because women were tested often and because cervical cancer grows slowly. Those in the Pap group who tested negative returned two years later for another and, if they tested negative again, returned at the end of the four-year study.

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