What's the best test for cervical cancer? Pap, HPV or both?

High grade dysplasia (carcinoma in situ) in the uterine cervix. The abnormal epithelium is extending into a mucus gland to the left of centre. This disease can progress to invasive cancer (squamous cell carcinoma) of the cervix. Credit: Haymanj/public domain

Should U.S. women be screened for cervical cancer with Pap tests, HPV tests or both? According to researchers from Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) while the merits of screening tests and screening intervals warrant further discussion, they firmly believe that increasing the number of women who participate in cancer screenings and ensuring that women are not lost to follow-up with lengthened screening intervals is more important than the choice of test to decrease rates of cervical cancer.

In a commentary in this week's issues of Annals of Internal Medicine, Drs. Rebecca Perkins and Elizabeth Stier provide insight into the benefits and limitations of discussing the advantages, disadvantages and questions related to screening with Pap tests only, HPV tests only, or Pap and HPV tests together.

The Pap test has been considered a cornerstone of women's health for more than 60 years. In a new era of cervical cancer prevention, the FDA in 2014 approved the Cobas HPV test as the primary screening tool for cervical cancer for women aged 25 and older. However, questions remain regarding how HPV testing alone will be recommended for screening.

According to the researchers, testing with both Pap and HPV together (co-testing), detects the most cervical pre-cancer, but the improvement over HPV testing alone is small. "A single Pap test does not provide good protection against cancer, but repeat testing every three years has been shown to effectively reduce cancer rates, and it is the only method for which long term data are available," explained co-author Rebecca Perkins, MD, MSc, assistant professor of Obstetrics and Gynecology at BUSM and a gynecologist at BMC. Questions remain however regarding the cost of each test, and how often women will be asked to be screened.

"We also must remember that the majority of cervical cancers occur in who have not had any recent screening and that increasing HPV vaccination rates will also be important to reducing cervical cancer rates in the future," she added.

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