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 ā„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 ā„ASCUS at that time they underwent colposcopy. Those randomized to HPV testing didnāt 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 āexitā testing with both HPV and cytology testing. The primary endpoint of incidence of ā„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 ā„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 ā„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 ā„ASCUS at that time they underwent colposcopy. Those randomized to HPV testing didnāt 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 āexitā testing with both HPV and cytology testing. The primary endpoint of incidence of ā„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 ā„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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