Using a computer model to simulate a large population of women 20 and older, the researchers evaluated the effectiveness of screening women with a combination of screening strategies—with both the HPV and Pap tests, with the Pap smear alone, or with only the HPV test. They found that using both screening tests, as opposed to the Pap test alone, would detect an additional 225 cancers per 100,000 women. The detection of these cancers would decrease cervical cancer mortality by 59%. HPV is a sexually transmitted virus and one of the leading causes of cervical cancer.
Current clinical guidelines recommend that women receive the Pap test alone every one to three years. Guidelines recently published by the American Society for Colposcopy and Cervical Pathology recommend HPV testing for women whose Pap test results are abnormal but inconclusive. The Georgetown study goes a step further by suggesting that adding the HPV test to biennial Pap tests at the outset is a cost-effective and potentially life-saving alternative for routine screening.
The incidence and death rates from cervical cancer have declined substantially in the United States over the last 50 years due to widespread Pap smear screening programs, but prior studies have shown that as many as half of all precancers or cancers could be missed by the Pap test. The HPV test detects the presence of the virus, whereas the Pap test (named for test designer George Papanicolaou) detects early abnormal cell changes that could lead to cervical cancer.
“For years, Pap smears have been the standard of care in screening for cervical cancer,” said Jeanne Mandelblatt, MD, professor of oncology and lead author of this paper. “What we’ve found is that adding an HPV test upfront not only increases cancer detection rate, it is also cost-effective to do so.”
However, the authors noted, “regardless of the method, the greatest health gains from screening will depend on reaching all women and ensuring access to diagnosis after an abnormal screening result.”
Funding for this study was provided by the National Institute on Aging and the U.S. Army.
Georgetown University Medical Center includes the nationally ranked School of Nursing & Health Studies, the School of Medicine, the Lombardi Cancer Center and a $120 million biomedical research enterprise. The Lombardi Cancer Center is one of only 40 National Cancer Institute-designated comprehensive cancer centers in the nation, and the only one in the Washington DC area.
Journal
JAMA