- NEW YORK (Reuters
Health) - Switching from Pap smears to human papillomavirus (HPV) testing
as the primary screening method for cervical cancer could improve detection
rates, a research team suggests. They also say that, with appropriate repeat
screening, this strategy would not increase rates of referral for more
invasive tests, which can sometimes be unnecessary.
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- In the current of The Lancet, Dr. J. Cuzick, at the Cancer
Research UK in London, and associates outline a screening approach in which
women would first be screened for HPV, a virus associated with the majority
of cervical cancers, and those testing positive would then have a Pap test.
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- But "for HPV testing to be cost effective in primary
screening, it would be necessary to develop an efficient policy for the
management of women who test positive for high-risk HPV types," but
have negative or borderline results on Pap screening, the team points out.
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- To explore the possible approaches for cervical cancer
screening, the investigators studied 10,358 women, ages 30 to 60, who underwent
cervical tissue testing (Pap smears) and who also had an HPV test.
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- Overall, HPV testing was more sensitive than Pap tests
(97.1 percent vs. 76.6 percent) in detecting precancerous cervical tissues.
The rate of false-positive tests was slightly higher with HPV testing than
with Pap tests.
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- Among the study subjects, 825 women had borderline Pap
results or positive high-risk HPV test results and negative Pap results.
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- Of this subgroup, 414 women were randomly assigned to
undergo more extensive cervical tissue removal (colposcopy) and 411 women
were assigned to have repeat HPV and Pap testing after 12 months (411 women)
and then undergo colposcopy if needed. Low-risk and high-risk cervical
tissue was identified in 7 percent and 3 percent of those who had immediate
colposcopy, versus 4 percent and 2 percent in the surveillance group.
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- Thus, the researchers deduce, "surveillance at 12
months was as effective as immediate colposcopy."
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- Their findings suggest that women who had borderline
Pap test results and negative HPV tests could have been safely returned
to routine screening every three to five years without the need for additional
follow-up.
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- In a related editorial in The Lancet, Dr. Eduardo L.
Franco calls for further studies to define the duration of protection conferred
by a negative HPV result and the effectiveness of using Pap smears as a
second screening test.
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- Dr. Franco, from McGill University in Montreal, points
out that a cervical cancer screening program that focuses on HPV, a sexually
transmitted infection, will place "the emphasis of prevention not
only on women but on their partners as well."
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- SOURCE: The Lancet, December 6, 2003.
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