In the last five decades, the Pap smear test has been used to screen for early signs of cervical cancer. Organisations that develop cancer screening guidelines are wrestling with whether to recommend replacing co-testing with primary HPV testing as the optimal screening strategy.
There's a vaccine that prevents most cancer-causing strains of HPV, but once a person has become sexually active, it's too late to get it.
One caution about the study findings, says Dr. Carol Mangione, a USPSTF task force member and UCLA professor of medicine, is that screening - either kind - is what saves lives. It was published this month in the Journal of the American Medical Association. "Even if we could magically vaccinate 100 percent today, it would take 30 years for them to reach the age of 40, and to see a meaningful decrease in cervical cancer", Spitzer added. 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".
The team of researchers included 19,009 women over the age of 25 years and screened them using either Pap test alone or HPV testing alone.
Both tests are given in the same way, via a smear, so a woman's experience in the doctor's office would not be different if she had an HPV or older Pap test. At the end of the four-year study, the women were tested with both tests. Because the HPV test was more likely to pick up on pre-cancerous cervical lesions earlier in the study, these women were less likely to develop cervical cancer. Presently, HPV DNA tests are mostly ordered along with the Pap smear tests, but can be utilized only for women between 30 to 65 years of age.
Tuesday's report detailed the "exit" results of the study 48 months after the women were enrolled and first screened. The two groups were again tested with both the methods post of 4 years.
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The research came from doctors and scientists working on Canada's cervical screening programme, including researchers from the University of British Columbia, British Columbia Centre for Disease Control, Lower Mainland Laboratories, British Columbia Cancer and McGill University. "The real benefit of co-testing is with the HPV test", she said.
This study suggests this change would lead to more cases of pre-cancerous lesions being found than under the current system. They also found that the HPV test was a better predictor of women who would be cancer free in future compared to Pap test.
"This supports the small, but significant benefit of co-testing". Where it is hard to apply HPV tests over pap smear for USA as there hasn't been head to head comparison until now. It adds to a body of research suggesting that HPV testing might be more accurate. They could also get a Pap test every three years. They also found that women with negative HPV test were more likely to not have cancer for the next four years, compared to the ones that had a negative Pap test.
"But we will gradually move to more HPV testing for primary screening", he said. Infection with HPV types targeted by the vaccine has declined by almost two-thirds among teenage girls since HPV vaccination was recommended in the United States, according to a study that also found that there was a decrease in HPV infections among women 20 to 24.
The United States Preventive Services Task Force, an independent panel that reviews the evidence of effectiveness for preventive services, now recommends the "co-testing" for signs of cervical cancer that other groups advocate.
According to the American College of Obstetricians and Gynecologists, women aged 21 to 29 should have a Pap test alone every three years. This new study could prove important in deciding on practice guidelines. 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.
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