"In the US, co-testing is now the recommended gold standard, and neither doctors nor their patients should be willing to give up the added benefit you get from screening with a Pap test and HPV test together", he says.
In 2018, the American Cancer Society expects more than 13,000 new cases of cervical cancer and more than 4,000 deaths from it. HPV causes the vast majority of cervical cancers, experts agree.
Patients with breast cancer may be missing out on genetic tests that could pinpoint the ideal treatment regimen, despite current practice guideline recommendations, Reuters reported. But last fall, it issued a draft recommendation proposing that women undergo either HPV testing every five years or Pap smears every three years, but a final recommendation has not been released.
At the start of the HPV FOCAL trial, some women received HPV testing and some had a Pap smear; those in the Pap smear group who tested negative had a second Pap after two years. If the guidelines change, and people over 30 switch to the HPV test, doctors will still most likely recommend that sexually active patients younger than 30 stick with the Pap smear.
After four years it was found that nearly six women in 1,000 who had been screened as negative with Pap test alone had pre-cancerous lesions while two women in 1,000 with negative HPV testing showed precancerous lesions. They checked on almost 19,000 women and found that detecting HPV was more predictive of early stage cervical cancer than the routine Pap tests.
The researchers said their results show that "primary HPV testing detects cervical neoplasia earlier and more accurately than cytology", adding that it "detected significantly more CIN3+ and CIN2+ cases in the first round and significantly reduced CIN3+ and CIN2+ rates 48 months later". Despite the widespread use of cervical cancer screening with a Pap smear, it was estimated that approximately 12,820 women in the United States would develop, and 4210 would die, from cervical cancer in 2017. "It shows that doing HPV testing alone provides a high degree of accuracy" on who might be at risk for cervical cancer.
Almost all cases of cervical cancer are caused by persistent infections of high-risk HPV, which causes changes to cervical cells.
Most cases are preventable with screening the best way of catching it before it develops. He cites the small group of women who had abnormal cells discovered through a Pap smear at the end of the study period. "They usually take up to 10 years to progress to cancers, but the point is if you don't find them, and you don't know how long they've been there, there is a chance that they could progress to the invasive form of cervical cancer". However, it looks like neither test was completely certain, as abnormalities were found in women from both groups who tested negative previously. The women who actually received Pap smear showed twice more chances of having abnormal cells.
Most cervical cancers are caused by a particular strains of the Human papillomavirus, or HPV.
Medical students learn how to insert a speculum, part of the process of performing a Pap smear.
But HPV testing is thought to have a lower specificity for CIN2+ than cytology screening, which could result in more colposcopies and biopsies being performed - some of which may be unnecessary, says the author of a related but separate JAMA editorial.
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