Researchers at the National Cancer Institute reported that testing for HPV (human papillomavirus) is the most effective way to determine whether a woman is at risk for developing cervical cancer in the near future. Specifically, the study found that negative HPV tests provided a more reliable assurance that women would not develop cervical cancer within three years of the test than do negative Pap smears.
Approximately 79 million people have the HPV infection—which is sexually transmitted—though most do not know they have it because symptoms are uncommon.
The HPV test looks for evidence of a virus (papillomavirus), which has been determined to cause 91% of all cervical cancers. On the other hand, a Pap smear is a test that looks for abnormal cervical cells themselves.
Nationwide, 12,000 women are diagnosed with cervical cancer every year, with 4000 dying from the disease.
Government recommendations in 2012 called for women between 21 and 65 to be screened with a Pap test every three years.
For this study, researchers looked at data for one million women between the ages of 30 and 64 who had been screened for cervical cancer since 2003. They followed women who had received a negative finding from either test. Researchers found that only 11 women out of 100,000 developed cervical cancer in the ensuing three years after a negative HPV test. Almost double that rate, or 20 out of 100,000, developed the malignancy after a negative Pap test. For those who had both tests, termed “co-tests,” the rate of malignancy five years later was 14 per 100,000.
The author of the study concluded that primary HPV screening might be a viable alternative to the Pap testing alone.
In another study designed to assess how well HPV tests and Pap tests detect cervical abnormalities, researchers evaluated information from more than 330,000 women age 30 and older.
- The five-year risk of cervical cancer or precancer (CIN3+) was very low for women who had both a normal Pap test and a negative HPV test: 3.2 per 100,000 women per year.
- Considering each test individually, a normal Pap test was not as useful as a negative HPV test in identifying low-risk women. The rate of cervical cancer or precancer was 3.8 per 100,000 women per year among those with a negative HPV test, but 7.5 per 100,000 women per year among those with a normal Pap test.
- The HPV test was also better than the Pap test at identifying high-risk women. Women who tested positive for HPV had a higher risk of cervical cancer or precancer than women with an abnormal Pap test result.
- One important role for the Pap test may be further evaluation of women with a positive HPV test. Among women with a positive HPV test, the risk of cervical cancer or precancer was highest among those who also had an abnormal Pap test result.
In a prepared statement, the lead author of the study concluded “Our results are a formal confirmation that the three-year follow-up is appropriate and safe for women who have a negative HPV test and normal Pap result. These results also suggest that an HPV-negative test result alone could be enough to give a high level of security for extending the testing interval to every three years, but we’ll need additional evidence from routine clinical practice, and formal recommendations from guideline panels before that can be routinely recommended.”2
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References:
- Gage, Julia, et al. A negative HPV test may predict lower cervical cancer risk than a negative Pap.J Natl Cancer Inst (2014) 106(8): dju251doi: 10.1093/jnci/dju251
- Katki HA, Kinney WK, Fetterman B et al. Cervical cancer risk for 330,000 women undergoing concurrent HPV testing and cervical cytology in routine clinical practice. Paper presented at: 2011 Annual Meeting of the American Society of Clinical Oncology; June 3-7, 2011; Chicago, IL. Abstract 1508.
