Should HPV Test Replace the Pap Smear?

Italian researchers urge a change in test for cervical cancer, but U.S. experts are mixed

By Amanda Gardner
HealthDay Reporter

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TUESDAY, Jan. 19 (HealthDay News) -- DNA testing for the human papillomavirus should replace the Pap smear as the main way to screen women for cervical cancer, according to Italian researchers.

Their recommendation is based on a study that found that the human papillomavirus (HPV) test prevented more cases of cervical cancer than the conventional Pap smear. Results of the study were published online Jan. 19 in The Lancet Oncology.

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The HPV test should become the screening tool of choice for women 35 and older, the researchers said. It could be done less frequently than the Pap test, which could be used only in women who have tested positive for HPV, they said.

The Pap smear, first introduced in the 1950s, looks for changes in the cervix that could lead to cervical cancer. The HPV test works a step further back in the process, looking to see if women are infected with HPV.

HPV causes cervical cancer, which remains a significant health problem, particularly in less resource-rich areas of the world.

DNA testing for HPV, though, does have drawbacks -- namely that it is less specific, meaning it is likely to pick up more false-positives, than a Pap smear. This results in many more callbacks for women to undergo further testing.

Using HPV as a primary screening tool results in a callback rate of about 25 to 30 percent, said Dr. Mark Einstein, a gynecologic oncologist and director of clinical research at Montefiore Medical Center in New York City. By contrast, Pap smears have a callback rate of about 5 to 7 percent, he said.

For their study, the Italian researchers compared HPV testing alone with HPV testing plus a Pap smear in 94,370 women aged 25 to 60 years old.

During the first phase of the study, women 35 to 60 who tested positive for HPV were given a cervical examination, called a colposcopy. Younger women got a colposcopy if their Pap smear was abnormal or if HPV results were positive several times, indicating that their body had not been able to clear the infection.

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