Pap Smear Plus Human Papillomavirus Test Can Stop Cervical Cancer Development

Testing for the human papillomavirus (HPV), in addition to a pap smear, increases cervical precancer detection and shortens time to detection, a recent study indicates.

HPV is the most common sexually transmitted infection and nearly all sexually active individuals will contract the infection at some point in their lives, according to the study authors.

Although the body will often clear the virus on its own, HPV can persist and can lead to the development of precancerous lesions and cervical cancer. Worldwide, more than 520,000 cases of cervical cancer are diagnosed each year, causing approximately 266,000 deaths.

For the study, published in JAMA Oncology, investigators used data from the New Mexico HPV Pap Registry to evaluate the impact of HPV testing on long-term outcomes of women who received a borderline abnormal Pap test result.

Included in the study were 457,317 women, of whom, 4.5% received a borderline abnormal result from a Pap smear. Some of the women with borderline abnormal Pap smear results had an HPV test. The participants were followed for 5 years.

The results of the study showed that testing for HPV led to a 15.8% overall increase in the detection of cervical precancers. Furthermore, time to detection was significantly shorter with a median of 103 days compared with 393 days.

A majority of the women who tested positive for HPV were detected to have cervical precancer. The findings suggest that HPV testing could be a beneficial additional screening method after the Pap smear. As a result, colposcopy could be reserved for women who test positive for HPV.

“The study showed that knowing a women’s HPV status can help determine her likelihood of needing additional procedures, and prioritize immediate treatment and medical resources to the women who need them most,” said Jack Cuzick, professor at QMUL’s Wolfson Institute of Preventive Medicine.

The study also showed that HPV testing resulted in 56% more biopsies and a 20% increase in surgical treatment procedures. Most of the biopsies were for low-grade lesions that could have regressed, suggesting that HPV testing causes some overtreatment.

However, Cosette Wheeler, UNM Comprehensive Cancer Center, said that “the benefits of HPV testing outweigh the harms observed but it’s important to understand and quantify the harms as well.”

Limitations to the study were that it was observational and the use of HPV testing was not randomized. Meaning, there could be socioeconomic or other relevant differences among health care facilities that were no measured, according to the authors.