A study regarding cervical cancer screening was released recently. It detailed HPV alone screening, Pap alone and Pap+HPV co-testing. According to the study’s press release, HPV testing alone screening is less likely to accurately detect cervical pre-cancer and cancer than testing that includes a Pap test in women 30-65 years of age.
An infographic illustrates that one in five women with cervical cancer are missed by HPV alone screening. This is an estimated 2,400 women with cervical cancer in the U.S. being missed annually.
One of the study’s authors, Dr. R. Marshall Austin, M.D., Ph.D., professor of pathology at Magee-Womens Hospital of University of Pittsburgh Medical Center in Pittsburgh, Penn., talked to Brandi Walker about why HPV alone screening has been ineffective in detecting cervical cancer, why the HPV+Pap screening is more effective and what is the overall best approach in detecting this illness.
1. Why is HPV screening alone ineffective in detecting cervical cancer?
HPV screening plays an important role in cervical cancer screening, as the vast majority of cervical cancers derive from the human papillomavirus, also known as HPV. For women over the age of 30, it is important that they receive both the HPV and the Pap test together because the HPV test identifies only the presence and type of HPV infection, while the Pap test detects cellular changes in the cervix. When Pap+HPV tests are performed together, they provide a more complete picture for clinicians to detect cervical pre-cancer and cancer. We recently conducted the largest real-world study analysis on cervical cancer screening strategies and found that screening with HPV alone misses one in five women with cervical cancer – that’s an estimated 2,400 women with cervical cancer in the U.S. who could be missed annually. That’s why using both tests at the same time is valuable.
2. Why is the HPV+Pap screening more effective in detecting cervical cancer?
In short, Pap+HPV screening remains the preferred standard in cervical cancer and pre-cancer detection by offering better detection and more protection than either test given alone. For women over 30, the Pap and HPV tests are most often performed simultaneously. The tests are conducted using the same sample, so there isn’t extra work on the part of the patient or the physician, but two tests are run by the lab for both the Pap and HPV tests. Our study evaluated effectiveness of HPV and Pap screening for cervical pre-cancer and existing cervical cancer and found nearly 19 percent of women with cervical cancer could be missed by HPV alone screening, compared to 12 percent by the Pap test alone and 5.5 percent missed by Pap+HPV screening.
3. Why should women start getting the HPV+Pap screening in their 30s? Why not in their 20’s?
Although 8 out of 10 sexually active women and men will become infected with HPV at some point, most HPV infections will resolve on their own by the body’s immune system. Furthermore, while there is a high incidence of HPV in women in their 20s, cervical cancer rates are low. It is thought that for this age group, a positive HPV test could lead to unnecessary tests and treatments for these otherwise harmless infections. It may also lead to unnecessary colposcopies in women, especially in those under the age of 30. This is further supported by current guidelines which recommend screening women 21-29 with a Pap test alone every three years.
4. Are women who don’t get this screening at a higher risk of being diagnosed with cervical cancer?
Yes. Cervical cancer is usually preventable with proper screening. Yet nearly 4,000 women still die each year, largely due to lack of screening. Screening for cervical cancer is essential during most of a woman’s adult life, even if she is not sexually active or her partner is a women. While it’s not common, some cervical cancers arise without patients ever being exposed to HPV, so it’s important for women of all ages to have regular checkups with their healthcare provider to figure out an appropriate screening approach. With early detection, cervical cancer has a five-year survival rate of almost 100 percent.
5. How can you incorporate a HPV standalone test within guidelines?
Last year’s FDA approval of a standalone HPV test sparked a serious debate about how best to detect cervical cancer, with some even suggesting the removal of the Pap test from frontline screening. This could have tragic outcomes, as our study found that Pap+HPV screening identifies more than 70 percent of cancers that would otherwise be missed by HPV alone. We’ve made considerable progress over the decades when it comes to cervical cancer prevention, and we certainly don’t want to reverse that. The Pap test is the most successful cancer screening tool in history and helped dramatically decrease cervical cancer death rates year-over-year since its introduction in the 1950s. We hope the medical community takes these findings seriously as it considers the best screening approach to promote favorable health outcomes for women.
6. What is the best approach in detecting cervical cancer?
It’s important to remember that the best approach for cervical cancer screening varies based on a woman’s age and other factors. Current professional guidelines recommend screening with the Pap alone for women ages 21-29 or Pap+HPV screening for women ages 30-65. Our study showed that Pap test – whether alone or combined with the HPV test – reliably detected more cervical cancers than HPV alone, which further affirms that the Pap test should continue to play a frontline role in the battle against cervical cancer.