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Globe and MailLooking for the HPV virus is a far more effective means of detecting cervical cancer in its early stages than the traditional Pap test, according to new Canadian research. The study, published today in the New England Journal of Medicine, shows the test for human papillomavirus detected 95 per cent of cases in which women had precancerous changes to their cervix, compared with a 55 per cent detection rate with the Pap test. ...
The Papanicolaou (Pap for short) test requires a laboratory technician to spot abnormalities in cell samples under a microscope. The HPV test is an automated procedure that detects the DNA of high-risk strains of HPV. Dr. Franco noted that the detection rate using a Pap test is "only a tad better than flipping a coin." The test generates a lot of false negatives - meaning it misses some cases of cancer. The HPV test, on the other hand, generates some false positives, meaning it might suggest cancer when there is none. The HPV test gave a false reading 6 per cent of the time, compared with only 3 per cent for the Pap test. Dr. Franco said that, based on the research, he would like to see women screened for cervical cancer using the HPV test and, when the virus is detected, there is a follow-up test to look for cellular changes as is now done with a Pap test. "This would be a reversal of our current approach," he said.
Currently, screening for cervical cancer is done using the Pap test and, only when the results are unclear, is the HPV DNA test used. Another test, a colposcopy, is required to confirm a cancer diagnosis. A Pap test costs about $25, while an HPV test costs about $90. In most cases, only the Pap test is covered under medicare; the HPV test must be paid out-of-pocket.
Joan Murphy, head of the divisions of gynecology and gynecologic oncology at The University Health Network in Toronto, said the new study is "tremendously important" and she hopes it will prompt provincial health plans to offer HPV testing at no cost. Mass testing could bring the cost down to as little as $5. "This study shows us that an HPV test is much more reliable at picking up disease when it exists and, even more importantly, it's better at eliminating the risk of disease," Dr. Murphy said.
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The Pap smear has led to a 70% drop in the U.S. cervical cancer death rate over the past six decades, and there is so much more that we can and should be doing on the testing front to eliminate cervical cancer mortality.