Is 'co-testing' for disease on the way out?

HPV tests may replace Pap smears regarding cervical cancer changes, study suggests

Pap smears may be on the way out, replaced by a test for HPV, when it comes to detecting cancerous cervical changes.

At least that's what a new decade-long study involving some 19,000 women suggests might happen (because the Human PapillomaVirus test apparently is more sensitive and more accurate).

The study, published yesterday in the Journal of the American Medical Association, was reported in a Laurie McKinley story in The Washington Post.

Dr. Gina Ogilvie

Dr. Gina Ogilvie, a professor at the University of British Columbia in Vancouver and lead author of the study, has cited a particular benefit — the research showing "women who received HPV testing have more reassurance with a negative test and can likely get screened less frequently."

Mark Schiffman of the National Cancer Institute, an HPV researcher himself, confirmed "that it's important to move from the Pap smear to the HPV test alone," according to the Post article. 

He also reportedly maintains that the Pap smear, which he calls "crude and inaccurate," worked only because women were tested often and because cervical cancer grows slowly.

HPV, the Post piece says, "is the most common sexually transmitted infection and is usually eliminated by the immune system. But when an infection persists, it can cause cellular changes that develop into precancerous lesions and eventual malignancies."

McGinley's story notes that "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 42,000 women will die of the disease."

In recent years, the article continues, "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, however, many experts are saying the Pap smear should be dropped. That position is still challenged by others who claim "that the Pap smear can catch a small number of cases of abnormal cells that might be missed by the HPV test."

The conventional Pap smear has already been replaced to a large degree by liquid-based Pap cytology tests.

The Post piece contends that "most medical groups," including the American Cancer Society and the American College of Obstetricians and Gynecologists, urge "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."

McGinley's story also notes that "about 80 million people in the United States are infected with HPV [although] most never develop any health problems because most infections go away by themselves, according to the Centers for Disease Control and Prevention."

Doctors have long urged children and young adults be vaccinated against HPV with a shot approved in 2006 by the Food and Drug Administration.

More details about cancer research can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.