New cervical cancer test more accurate than Pap

Stephanie Nano

NEW YORK — A relatively new screening test was about twice as accurate as the traditional Pap smear at spotting cervical cancer, according to the first rigorous study of the test in North America.

The new test could replace the 50-year-old Pap in a matter of years, experts say. And there’s a bonus for women: They won’t need a screening test as often.

The HPV test, which looks for the virus that causes cervical cancer, correctly spotted 95 percent of the cancers. The Pap test, which checks for abnormal cells under a microscope, only found 55 percent, according to researchers at McGill University in Montreal, who published their findings in the Oct. 18 issue of the New England Journal of Medicine.

“We’ve had the Pap test for over 50 years and it’s high time it be replaced by technology that’s more robust,” said Eduardo Franco, director of McGill’s division of cancer epidemiology, who led the study.

Franco said some feared the HPV test would result in more false alarms, causing anxiety and requiring more follow-up testing. In the study, there were only slightly more false positives for the HPV tests (6 percent) than the Pap smears (3 percent).

HPV, or human papillomavirus, is a common sexually transmitted disease. Infections are most common in young women, and most go away on their own. The HPV test looks for the high-risk viruses that can cause cervical cancer if the infection persists. Like the Pap, it uses cells scraped from the cervix, the lower part of the uterus.

Because the Pap test misses about half of the cases, doctors use frequent testing to catch the slow-developing cancer at its earliest, most treatable stages.

The HPV test has been available in the U.S. since 2000 and was first used for inconclusive Pap tests. Now women over 30 can get a HPV test — but only along with a Pap — and wait three years to be tested again if both tests are negative.

More recently, scientists have been studying whether the HPV test can be used alone and whether it can prolong the intervals between exams. Debbie Saslow, director of breast and gynecologic cancer for the American Cancer Society, said evidence from a number of studies supports using the HPV test in place of a Pap.
“Overall, I don’t think there’s any doubt that HPV testing has a lot of advantages over the Pap test,” she said.

Saslow said there are still issues to be resolved, and federal approval needed, but “it’s definitely coming.” She said experts expect that to happen sometime in the next decade.

A Swedish study also in the journal compared Pap with HPV testing to Pap alone in 12,527 women in their 30s. They found the combo test detected precancerous lesions or cancer earlier than the Pap test alone.

The Canadian study, which was government-funded, included 10,154 women ages 30 to 69 in Montreal and St. John’s, Newfoundland. The women got both tests. Still to be determined is the best way to start using the HPV test by itself and what follow-up action to take after positive results, the researchers said.

The HPV test is more expensive: In the U.S., Medicare pays about $50 for the HPV test and $15 to $28 for a Pap test.

Some of the researchers have received fees or grants from drug makers including Merck Frosst Canada Ltd., a subsidiary of Merck & Co., which makes a cervical cancer vaccine. One researcher has stock in Digene Corp., which developed the only approved HPV test.

Franco emphasized that girls who have been vaccinated against HPV will still need to be screened because the vaccine only protects against some of the cancer-causing strains.

Dr. Carolyn D. Runowicz, who wrote a journal editorial, noted that the two studies used a different kind of Pap test, not the liquid-based technology used in the U.S., which may be more sensitive. The results of a British study that used liquid Pap are due to be presented this month.

“We’re not ready for prime time,” said Runowicz, a former president of the American Cancer Society. “We’re moving in that direction. But we’re not there yet.”

(Associated Press)