HEADLINES Published January13, 2015 By Bernadette Strong

Will a Test for HPV Replace the Pap Test?

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A microscopic view of normal cervical cells, taken with a Pap test.
(Photo : Department of Pathology, Calicut Medical College, commons.wikimedia.org)

Women between the ages of 25 and 65 should be screen regularly for cervical cancer during a regular gynecology exam. Currently, cervical cancer screening includes both a Pap test and testing for human papilloma virus (HPV) because nearly all cases of cervical cancer are caused by HPV infections. But the Pap test appears to be on the way out as a first-line screening test.

In a Pap test, also called a Pap smear, a swab is used to collect cells from the cervix of the uterus. The cells are usually sent to a lab to be examined for abnormalities. The HPV test is similar, with a swab collecting a sample from the cervix. In fact, many labs now perform both tests on the same sample, a process called Pap and HPV co-testing. 

Last year, the U.S. Food and Drug Administration approved the use of a test for HPV as a first-line screening tool for cervical cancer. This approval was based on findings from a very large clinical trial. This HPV test was found to do better than the Pap smear at identifying women who are at risk for developing abnormal cells on their cervix. A woman who has a positive result with an HPV test then should have a Pap test done as a part of the follow-up along with other examinations.

Officially, most cancer organizations still call for a Pap smear alone or with an HPV test to screen for cervical cancer. However, new interim guidance on screening has been published stating that HPV screening can be considered as an alternative to Pap smears. There is a lower rate of false negatives, where the test says there are no abnormal cells but such cells are present, with the HPV test than with a Pap smear, the authors of the guidance state.

Current screening guidelines, according to the National Cancer Institute call for women to have their first screening for cervical cancer at age 21 and to be retested every 3 years through age 29. Women aged 30 through 65 can be retested every 5 years.

The interim clinical guidance was published in Gynecologic Oncology, Obstetrics & Gynecology, and the Journal of Lower Genital Tract Disease.

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