Screening for HPV could replace routine Pap smears

By Dr. Ananya Mandal, MDAug 22 2018

According to health advisors from the U.S. Preventive Services Task Force, Pap smears may not be the only way to check for cervical cancer risk among women. The women could be screened for Human Papilloma Virus (HPV) infection. HPV infection is known to be a risk factor for cervical cancers later in life. The recommendations are published in the latest issue of the JAMA.

Pap smear test. Image Credit: Iryna Inshyna / Shutterstock

Pap smears or exfoliative cytology testing, involve looking at samples of cervical tissues and checking for precancerous changes. For women aged 21 to 29 years, the USPSTF still recommends pap smears as the main test for detection of cervical cancer risks. Dr. Douglas Owens, a professor of medicine at Stanford University and vice chair of the USPSTF in a statement said, “Most cervical cancer is caused by what's called the human papillomavirus, or HPV. And we now have tests for HPV and that's an important step forward.” This means that women now could have an alternative to routine pap smears.

According to the USPSTF there is ample evidence that HPV tests can be used alone in women over 30 years to rule out the chances of their getting cervical cancer. The earlier recommendation from USPSTF suggested either Pap smear or a combination of Pap smear and HPV test as gold standards for cervical cancer screening. This new recommendation supports a third option of only the HPV test for women over 30 years.

The recommendation adds that Pap smears need to be taken every three years but the HPV test can be taken once every five years. Owens says, “Five years is a good balance between the benefits and harms. It's still highly effective at detecting cancer, and screening more frequently than that may increase some of the potential harms, so we think that's a good interval.” Owens explained that the main problem is that the HPV test is not available everywhere and they want to be sure that all women have the three options for cervical cancer screening before them. All women can discuss with their doctors regarding the options for screening that they can be offered said Owens.

According to Debbie Saslow, senior director for HPV-related and women's cancers at the American Cancer Society, if all women have a choice, those over 30 should go for the HPV test. She said, “I truly believe that including the HPV test, either along with the Pap or instead of the Pap, is superior than the Pap alone.” She explained that the HPV test is better at detecting some forms of adenocarcinomas of the cervix compared to Pap smears. This has been seen in some studies.

At present the recommendations emphasize that both tests are highly effective. The team emphasizes that all women should get screened regularly until the age of 65. They also recommend the HPV vaccine, which is given to girls and young women, up to age 26. This can provide some protection. Boys are also recommended to get vaccinated. Owens says that nothing can replace cervical cancer screening but HPV vaccination can prevent the infection in many women and offer some protection. He said, “Our recommendation applies to everyone whether you've been vaccinated or not. It's very important that women do not forgo screening because they've been vaccinated.”

The new guidelines summary;

• Women under 21 do not need testing
• Women aged 21-29 - Pap smear every 3 years
• Women aged 30-65 can get an HPV test every 5 years, or a Pap test every 3 years, or a combination every 5 years
• Women over 65 who have had recent clear tests probably don’t need testing any more

Source: https://jamanetwork.com/journals/jama/fullarticle/2697704