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Women Over 30 Might have a Better Option than the Pap Smear

Women Over 30 Might have a Better Option than the Pap Smear

The HPV test identified significantly more precancerous lesions earlier, and four years after the women were initially screened, they received both an HPV test and a Pap test.

But HPV testing is thought to have a lower specificity for CIN2+ than cytology screening, which could result in more colposcopies and biopsies being performed - some of which may be unnecessary, says the author of a related but separate JAMA editorial. The US Preventive Services Task Force now recommends a Pap smear every three years or co-testing every five years for women age 30 and up, but it is considering changing that recommendation to just one test or the other, and this study could speed things along, NPR reports. Further, Ogilvie added, "If women have a negative HPV test, they are significantly less likely to have a precancerous lesion four years later, meaning we can extend screening time". Quite often the smear test can be unpleasant for women, but luckily there is an easier way to screen for cervical cancer risk. It was published this month in the Journal of the American Medical Association.

But there have been some barriers to just replacing the older test with an HPV test, said Dr. Stewart Massad of Washington University School of Medicine in St Louis. He cites the small group of women who had abnormal cells discovered through a Pap smear at the end of the study period.

"If you tested everyone for HPV in their 20s, they are nearly all going to be positive, but there's going to be all of this intervention that's not needed", she says. She explained that at present the guidelines recommend that all women undergo both Pap test as well as HPV test.

As NPR reports, it's been hard to justify replacing the Pap smear with the HPV test because, until now, there hasn't been a head-to-head comparison.




When it comes to cervical cancer screening, most women receive a cytology-based Papanicolau (Pap) smear, where cells are scraped from the back of the cervix. The Pap smear has been around for 50 years, so co-testing remains a viable option, Wright said. More than 4,000 women die from it, even with screening and treatment.

Almost all cases of cervical cancer are caused by persistent infections of high-risk HPV, which causes changes to cervical cells. 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.

Studies like this one could lead to a change in guidelines, according to Dr. Chris Zahn, the vice president of practice for the American College of Obstetricians and Gynecologists. Two years later, the ones that tested negative after the Pap smear had another test of the same type. "In fact, at the conclusion of the study, all HPV-negative women were tested with the Pap smear, which led to finding additional cases of pre-cancerous lesions".

However, 48 months after the start of the study, there were fewer cases of CIN3+ among women who had HPV tests than among smear tests, presumably because they had been found and treated in the first round of screening.

But four years later, the referral rates were 49.2 per cent in the HPV group compared with 70.5 percent in the other, suggesting earlier detection of the virus. They recommend further studies to help researchers understand long-term clinical outcomes and cost-effectiveness across both tests. Partly because of that, he said, "we're a long way away from replacing the Pap smear". "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.