Efforts to prevent invasive cervical cancer should focus on increasing screening rates, regardless of which test is used, according to a commentary being published in Annals of Internal Medicine. Each year, approximately 12,000 women in the United States will be diagnosed with cervical cancer.
Nearly all cases of cervical cancer are caused by the human papilloma virus, or HPV. Screening tests for cervical cancer are intended to detect cancer at its earliest stages when death or impairment can be prevented. To be effective, screening tests should have high sensitivity (able to detect most disease), and acceptable specificity (relatively low false-positive rate). Current guidelines recommend routine cotesting for cervical cancer with an HPV test and Pap smear every five years or Pap smear testing alone every three years.
In April, the U.S. Food and Drug Administration approved the Cobas HPV test to be used alone to screen women aged 25 years and older for cervical cancer. The authors of a new commentary suggest that this switch in paradigm from Pap testing to HPV testing raises many questions about which test, or combination, is most effective, cost-effective, and would result in the least repeat testing.
The authors argue that most cervical cancer occurs in women who have not had any recent screening. Therefore, increasing population coverage with any screening test as well as ensuring that women are not lost to follow-up with lengthy screening intervals is more important than the choice of test.