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. Almost all cervical cancer cases are linked to HPV infection, and HPV testing detected pre-cancers earlier and more accurately than the Pap test among the 19,000 women in the Canadian study.
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 findings were published July 3 in the Journal of the American Medical Association.
"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.
"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. "Since it's a better test at about the same cost and can be done less often, it should replace Pap testing", he says. According to the study, this method is recommended for the women aged thirty and above.
Pap smears involve scraping cells from the cervix and examining them for cancerous changes, also known as "cytology" testing. HPV test is more accurate, leads to earlier diagnosis and also increases the interval between screening.
The authors stated that one of the concerns related to primary HPV screening is lower CIN2+ specificity, "leading to higher screen positive rates and the resulting need for more colposcopies and biopsies". Some of them used the regular Pap smear screening, while others used the HPV testing. 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 Task force states that for women aged between 29 and 65 HPV tests alone every five years can be the only screening test. Previous research has indicated that HPV testing alone or combined with a Pap smear is linked to increased detection of precancerous lesions in the first screening round, followed by a subsequent reduction in precancerous lesions. They can't rely on HPV testing, Schmeler says, because nearly everyone in that age group will contract HPV and in many cases it goes away on its own. It adds to a body of research suggesting that HPV testing might be more accurate.
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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.
But, neither testing method was found to be foolproof. 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.
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.
The new study will probably "help push that along", said Wright of NewYork-Presbyterian/Columbia University Medical Center.
Human papillomavirus (HPV) is a DNA virus from the papillomavirus family. They checked on almost 19,000 women and found that detecting HPV was more predictive of early stage cervical cancer than the routine Pap tests.
Moving away from co-testing may not be a good idea, according to Mark Spitzer, an OB-GYN and past president of American Society for Colposcopy and Cervical Pathology.
"It's really unbelievable, there's no other test that gives us this level of reassurance for that period of time for a cancer", Harper says.