Source: Washington Post
A randomized, controlled study — the kind of trial considered the “gold standard” of research — has showed that the human papillomavirus test is more sensitive than the Pap smear, a widely used test that has been a standard part of women’s preventive health care for decades but has several drawbacks.
HPV is the most common sexually transmitted infection and is usually eliminated by the immune system within a year or two year. But when an infection persists, it can cause cellular changes that develop into precancerous lesions and, eventually, malignancies. Almost all cases of cervical cancer are caused by HPV infections.
About 13,240 new cases of invasive cervical cancer will be diagnosed in the United States in 2018, according to the American Cancer Society. About 4,200 women will die of the disease.
As experts learned more about HPV’s role in cervical cancer, most medical groups have recommended that women in the United States get both the HPV test and the Pap smear — a practice called “co-testing.” Now, armed with the new and previous studies, some experts say the Pap smear should be dropped. But others disagree, saying that the Pap smear can catch a small number of cases of abnormal cells that might be missed by the HPV test and that co-testing should continue.
The National Cancer Institute’s Mark Schiffman, who has done extensive research on HPV, said the study confirmed that it’s important to move from the Pap smear to HPV alone. “This has been building for decades,” he said, adding that the Pap smear is “crude and inaccurate” while the HPV test is much more precise, operates on the molecular level and can provide information on the specific type of HPV causing the problem. The Pap smear only worked, he said, because women were tested often and cervical cancer grows slowly.
Most medical groups recommend that women of average risk get both HPV tests and Pap smears every five years between age 30 and 65, though they say a Pap test alone every three years is an acceptable alternative. Women in their 20s are advised to get Pap smears, not HPV tests, because the virus is so common that most would test positive for infections that would most likely clear up on their own.
About 80 million people in the United States are infected with HPV, but most never develop any health problems because most infections go away by themselves. But when infections last longer, they can cause not only cervical cancer but also cancer of the anus and back of the throat, as well as cancer of the penis in men. That’s why doctors strongly recommend that children and young adults be vaccinated against HPV; a vaccine was approved by the Food and Drug Administration in 2006.