Pap test.
Top Line: Women continue to benefit from Paps, but this may more commonly become shorthand for human papillomavirus (HPV) testing than for Papanicolaou smears.
The Study: The large Canadian phase 3 HPV FOCAL trial randomized >1900 women to screening with HPV testing versus standard cytology testing via Pap smear. All women were ages 25-65 with no history of cervical intraepithelial neoplasia (CIN) 2 or greater. Those randomized to standard cytology underwent a Pap smear with liquid-based cytologic assessment (cervical cells were rinsed in preservatives to wash away obscuring material). If negative, they came back at 24 months. If cytology demonstrated ≥ASCUS, they had reflex HPV testing. If HPV(+) they underwent colposcopy and if HPV(-) they were given a second chance at 12 months. If still ≥ASCUS at that time they underwent colposcopy. Those randomized to HPV testing didn’t have to come back until 48 months if HPV(-). If HPV(+) they underwent a similar but opposite algorithm with reflex cytologic testing. At 48 months, all women underwent “exit” testing with both HPV and cytology testing. The primary endpoint of incidence of ≥CIN3 at 4 years was double among those undergoing standard cytology screening versus HPV screening. Why? Probably because primary HPV testing detected almost double the ≥CIN2 cases the first go-round. Great news for diminishing cervical cancer deaths through more effective secondary prevention. Bad news is it still requires a brush up the cervix, which should lead us all to continue to perfect the uptake on primary prevention.
Bottom Line: Cervical HPV screening detects cervical neoplasia more accurately than standard cytologic screening. | Ogilvie, JAMA 2018
The Study: The large Canadian phase 3 HPV FOCAL trial randomized >1900 women to screening with HPV testing versus standard cytology testing via Pap smear. All women were ages 25-65 with no history of cervical intraepithelial neoplasia (CIN) 2 or greater. Those randomized to standard cytology underwent a Pap smear with liquid-based cytologic assessment (cervical cells were rinsed in preservatives to wash away obscuring material). If negative, they came back at 24 months. If cytology demonstrated ≥ASCUS, they had reflex HPV testing. If HPV(+) they underwent colposcopy and if HPV(-) they were given a second chance at 12 months. If still ≥ASCUS at that time they underwent colposcopy. Those randomized to HPV testing didn’t have to come back until 48 months if HPV(-). If HPV(+) they underwent a similar but opposite algorithm with reflex cytologic testing. At 48 months, all women underwent “exit” testing with both HPV and cytology testing. The primary endpoint of incidence of ≥CIN3 at 4 years was double among those undergoing standard cytology screening versus HPV screening. Why? Probably because primary HPV testing detected almost double the ≥CIN2 cases the first go-round. Great news for diminishing cervical cancer deaths through more effective secondary prevention. Bad news is it still requires a brush up the cervix, which should lead us all to continue to perfect the uptake on primary prevention.
Bottom Line: Cervical HPV screening detects cervical neoplasia more accurately than standard cytologic screening. | Ogilvie, JAMA 2018
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