The cytology-based Pap smear includes searching for tumor or pre-cancer cells by testing cells obtained from the lower end of a female uterus, known as the cervix. detecting the diseases by observing a single cells and little groups of cells is known as cytology or cytopathology.
The HPV test found nearly 60 per cent more precancers - or abnormal cells that could potentially become cancerous - during the initial screening than the Pap test, said study co-author Dr. Dirk van Niekerk, a pathologist who is also the medical leader of the cervical cancer screening program at the B.C. Cancer Agency.
Numerous medical groups have said that before moving to HPV testing only, they needed to see clinical trial results - such as the kind provided by the new head-to-head study - to determine which test, over time, was better at detecting the precancerous changes. They noted that women who had a negative HPV test were more likely to be cancer free for the next four years compared to those who got a negative Pap test. "The HPV virus is the cause of 99 per cent of the cervical cancers".
"Most cases of cervical cancer happen in women who have not been regularly screened, or who have been screened, but don't have access to appropriate treatment", she says.
Lead author Dr. Gina Ogilvie is in favor of a shift from Pap smears to HPV testing. Infection with HPV types targeted by the vaccine has declined by almost two-thirds among teenage girls since HPV vaccination was recommended in the United States, according to a study that also found that there was a decrease in HPV infections among women 20 to 24. They could also get a Pap test every three years.
Even the most ideal tests can also be limited by the fact that not all women are receiving regular and timely screening. The vaccine is given to teens and young adults, but generations of women are still at risk of cervical cancer because HPV eventually infects most people at some point.
For more on cervical cancer screening, visit the American College of Obstetricians and Gynecologists.
However, because all women who were HPV test negative in the study also received a Pap smear, additional cases of early cancer were detected.
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After follow up, researchers determined HPV testing detected significantly more CIN3+ cases in the first round of screening than did the Pap test (P .001). "This trial. found primary HPV testing detected significantly more CIN3+ and CIN2+ cases in the first round and significantly reduced CIN3+ and CIN2+ rates 48 months later". The study inferred that HPV testing could be comparatively much more accurate.
After four years, the women who got HPV tests were less likely to have serious changes that can lead to cervical cancer, a diagnosis of cervical intraepithelial neoplasia 2 or 3 (CIN2 and CIN3), Ogilvie's team found.
One limitation of the study was that it was done in a specific area of Canada and the findings may not be generalized to other populations.
Half of the women in the study were randomized to get the HPV test and half to the standard Pap smear screening alone. After four years, all the women also got tested with both types of test.
At present, the NHS screening programme for cervical cancer starts with a smear test. Women whose smear test results show possible low-grade or borderline changes to cells will have the sample tested for HPV. But there were still no final guidelines issued on this and that's why the new study might be important in helping with the decision.
Most cervical cancers are caused by a particular strains of the Human papillomavirus, or HPV.
Moving away from co-testing may not be a good idea, according to Mark Spitzer, an OB-GYN and past president of American Society for Colposcopy and Cervical Pathology.
Medical students learn how to insert a speculum, part of the process of performing a Pap smear.
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