Recent studies have addressed the distinct difference in sensitivities between Pap tests and HPV testing. HPV testing alone has been shown to be significantly more sensitive when compared with Pap tests only, and co-testing (the Pap Test + HPV Test) has emphasized that distinction. When co-testing has been performed, the increased sensitivity of the HPV test has suggested that the Pap test contributes little to the goal of cancer screening except cost.
In cases in which the co-test has shown to be HPV positive and Pap test normal, approximately 10% of these patients will have significant abnormalities of the cervix. Pooled data from four randomized controlled trials of primary HPV screening showed that women who were screened with HPV testing only compared with a Pap test only were at significantly decreased risk of invasive cervical cancer.
Primary screening with DNA-based HPV testing is not only convenient, but also sensitive. The convenience of self-collected vaginal samples, which have shown to be equally sensitive when compared with clinician collected specimens, may obviate any delays in screening and eliminate any concerns regarding prolonged intervals between screening. More frequent self-collected vaginal samples for HPV testing are accessible, cost effective and well accepted by patients!
Increased understanding of the natural history of cervical cancer, and the essential role of HPV, has prompted many countries to move towards a screening program that uses molecular testing for high risk HPV alone as the primary screening test. However, it is also known that in high risk HPV positive women, the risk for high grade dysplasia or invasive carcinoma is not the same for all high-risk HPV types. One study confirmed that women positive for HPV-16 were at the highest risk of high-grade dysplasia in both the short and longer term, suggesting that HPV-16 is highly oncogenic.
The conclusion is that primary HPV testing, when positive, is a significant finding, and warrants further evaluation. Because of the recent trend of low participation in cervical screening in women of reproductive age, self-collection of vaginal samples for HPV testing is strongly encouraged because of accuracy, convenience and cost savings. Be Smart. Don’t be afraid. Get tested!