HPV-Only Testing Puts Cervical Health At Risk

Human papillomavirus, or HPV, is the most common STD in the U.S. In fact, 8 out of ten women and men will have HPV at some point in their lives and in most cases, HPV infections, including high-risk ones, will clear on their own by the body's immune system. However, some aggressive strains of the virus can cause cervical cancer.

Cervical cancer was once the most common cause of cancer death among women. Today, it is entirely preventable with proper screening. The Pap test is one of the most effective ways to detect cervical cancer early. Since its introduction in the 1950s, the rate of cervical cancer deaths has been plummeting year over year. Furthermore, in the 1990s, the medical community's understanding of cervical cancer grew to include the role of HPV. With this knowledge, HPV vaccination and testing was introduced, and cervical cancer rates continued to fall.

"Cervical cancer screening has been one of the great success stories in cancer prevention, and we owe much of this to the Pap test," said Guillermo Guzman, M.D., an obstetrician gynecologist at Saint Alphonsus Medical Group in Boise and Nampa. "Women should know and understand the types of tests they're receiving when deciding how to protect themselves from cervical cancer."

There are two screening tests that are used to detect cervical cancer: the Pap test, which screens for precancerous cellular changes in the cervix, and the HPV test, which identifies the presence and type of HPV infection. When both tests are performed simultaneously, it is called co-testing. Co-testing works just like the Pap test women have always known. One swab yields on sample---but two tests are run by the lab. However, there has been a growing debate within the medical community over the use of HPV-only testing as an alternative to Pap or Pap-plus-HPV co-testing.

According to a recent study in Cancer Cytopathology, a peer-reviewed journal of the American Cancer Society, HPV-only screening misses more cervical cancer in women than Pap-only or co-testing, based on approximately 8.6 million women ages 30-65 — the largest retrospective cervical cancer screening study ever conducted. Of the 526 women who were found to have cervical cancer, nearly 19 percent received negative results for cervical cancer when tested with HPV-only, compared to the 12 percent that were Pap-test negative and 5.5 percent that tested negative with co-testing — an approximately three-fold improvement in the cancer detection rate of co-testing compared to HPV only.

"We’ve made considerable progress over the decades when it comes cervical cancer screening,” said study co-author R. Marshall Austin, M.D., Ph.D., professor of pathology at Magee-Womens Hospital of University of Pittsburgh Medical Center in Pittsburgh. "This study provides convincing evidence that HPV-only testing would tragically miss many cervical cancers that would be detected if co-testing were employed — taking a large step backwards.”

These findings further support the current professional guidelines, which recommend women start getting the Pap test at age 21, every three years. Co-testing is recommended for women ages 30-65, every three to five years, regardless of whether they have received HPV vaccination.

“It’s important to remember that Pap test has proven to be one of the most successful cancer screening tests in history,” said Dr. Guzman. “It should continue to play a front-line role in the battle against cervical cancer.”

At your next doctor’s appointment, remember to ask your doctor about appropriate preventative measures, such as vaccinations and screenings, to help you live a healthy life.

* Dr. Guillermo Guzman is a practicing obstetrician gynecologist at Saint Alphonsus Medical Group in Eagle, Nampa and Ontario and Dr. R. Marshall Austin is a professor of pathology at the Magee-Womens Hospital of University of Pittsburgh Medical Center in Pittsburgh