Huh? HPV test better than Pap for cervical cancer screening

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Human papillomavirus (HPV) testing should be the first alternative when screening for cervical cancer in women as opposed to Papanicolau smear (Pap), says a document co-authored by Dr. Warren Huh of the Society of Gynecological Oncology and the American Society for Colposcopy and Cervical Pathology. However, some major medical organizations went ‘huh?’ at Dr. Huh’s recommendation. The new recommendation is based on a review of 11 studies and is published in Gynecological Oncology and two other medical journals. It advises women to be screened with an HPV test at 25 years of age. Should the results come back negative, they should not be screened again until they turn 28 years old. Conversely, if the results come back positive for the 16 and 18 strains of HPV, then a biopsy of the cervix should follow. Testing positive for other HPV strains should elicit a Pap smear. Women under 25 years of age should stick to the current Pap testing recommendation.

The American College of Obstetricians and Gynecologists (ACOG) was represented in the document’s authorship, but it nonetheless remains supportive of the government-backed U.S. Preventive Services Task Force (USPSTF) 2012 recommendation of screening women aged 21-65 with a Pap smear every 3 years, and co-testing – a combination of Pap and HPV test – women aged 30-65 every 5 years. According to Huh a great many people in their 20’s tests positive for a strain of human papillomavirus, so screening women in that age group with the HPV test results in unnecessary additional testing. “We think the balance of procedures and diseases are justifiable,” Huh said.

However, Dr. George Sawaya and Miriam Kuppermann wrote in an Obstetrics and Gynecology editorial about the risks of HPV testing, such as unexplained test results or results showing abnormal cells that are bound to disappear anyway. “Such surveillance recently has been found to be associated with significant psychological distress in 39 percent of women,” they wrote. Additionally, director of gynecologic oncology at the University of Rochester Medical Center in New York Dr. Brent DuBeshter, who wasn’t involved with the new recommendation, said that “because it’s so common and disease is so uncommon in that age range, you wouldn’t think it’s a very good age range for that.”

Both the Pap and the HPV test consist of scraping cells from the cervix and vagina; the former checks for abnormal, possibly pre-cancerous cells, while the latter looks for the human papillomavirus. The HPV test is FDA-approved, but Huh said “is getting accurate information to providers so they can understand the approach” is more important than the federal agency’s approval. The CDC recorded approximately 12,000 cases of cancer of the cervix in U.S. women in 2010, as well as 4,000 deaths. About 91% of cervical cancers are believed to result from HPV.

Related Read:

Docs suggest HPV screening first for cervical cancer.

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