A study in this week’s issue of The Lancet suggests that human papillomavirus (HPV) testing should become the primary screening tool to rule out disease for women 30 and older, with Pap tests reserved for testing of women in their 20s and for further testing of women who test positive for HPV. The study reports results from the ATHENA trial, with its authors concluding: “HPV testing with separate HPV16 and HPV18 detection could provide an alternative, more sensitive, and efficient strategy for cervical cancer screening than do methods based solely on cytology.”
Does this mean the days of the Pap test are numbered? We asked Debbie Saslow, Ph.D., director of breast and gynecologic cancer for a comment.
“This is a large study done in the U.S. that shows that screening for cervical cancer with the HPV test alone detects more precancers than the Pap test alone, confirming other studies from Europe and Canada.
“Co-testing with HPV plus Pap is recommended by the American Cancer Society for women starting at age 30. According to this and other studies, co-testing appears to offer little benefit yet increased harms over the HPV test alone. However, there are still many questions to be answered before the ACS and other organizations within the U.S. and internationally consider screening with HPV alone.
“One important question is what to do when an HPV test used alone comes back positive. This study looked at two possible follow up strategies: use the Pap test to detect precancerous changes that would indicate the need for colposcopy, or use an additional test on the sample to look for the two HPV strains that cause most cervical cancers (HPV16 and 18). Follow-up data from this and other studies will help inform future screening guidelines.”