HPV DNA Test Outperforms Pap Smear
A new DNA test for Human Papillomavirus (HPV) which causes cervical cancer is so much better than current methods that some gynecologists hope it will eventually replace the Pap smear in wealthy countries and other tests in poor ones. Not only could the new test for HPV save lives, scientists say that women over 30 could drop annual Pap smears and instead have the DNA test just once every 3, 5 or even 10 years, depending on which expert is asked. This optimism is based on an eight-year study of 130,000 women in India financed by the Bill and Melinda Gates Foundation and published recently in the New England Journal of Medicine:
HPV Screening for Cervical Cancer in Rural India. 2009 New Engl J. Med. 360: 1385-1394
In October 1999, we began to measure the effect of a single round of screening by testing for human papillomavirus (HPV), cytologic testing, or visual inspection of the cervix with acetic acid (VIA) on the incidence of cervical cancer and the associated rates of death in the Osmanabad district in India. In this cluster-randomized trial, 52 clusters of villages, with a total of 131,746 healthy women between the ages of 30 and 59 years, were randomly assigned to four groups of 13 clusters each. The groups were randomly assigned to undergo screening by HPV testing (34,126 women), cytologic testing (32,058), or VIA (34,074) or to receive standard care (31,488, control group). Women who had positive results on screening underwent colposcopy and directed biopsies, and those with cervical precancerous lesions or cancer received appropriate treatment. In the HPV-testing group, cervical cancer was diagnosed in 127 subjects (of whom 39 had stage II or higher), as compared with 118 subjects (of whom 82 had advanced disease) in the control group (hazard ratio for the detection of advanced cancer in the HPV-testing group, 0.47; 95% confidence interval [CI], 0.32 to 0.69). There were 34 deaths from cancer in the HPV-testing group, as compared with 64 in the control group (hazard ratio, 0.52; 95% CI, 0.33 to 0.83). No significant reductions in the numbers of advanced cancers or deaths were observed in the cytologic-testing group or in the VIA group, as compared with the control group. Mild adverse events were reported in 0.1% of screened women. In a low-resource setting, a single round of HPV testing was associated with a significant reduction in the numbers of advanced cervical cancers and deaths from cervical cancer.
Related:
- From India to the World – A Better Way to Prevent Cervical Cancer. 2009 New Engl J. Med. 360: 1453-1455
- Should we cure cancer?
- HPV vaccines: prospects for eliminating ano-genital cancer
- Dumb and Dumber
Tags: Biology, disease, DNA, Health, India, Medicine, Microbiology, Science, Virology, virus
that’s very good news! I am new to this website, but I absolutely love it…also, I was wondering if you could perhaps do some acheives on group A streptoccus. Anyway, keep up the good work
I am a western woman living in Morocco. As a victim of HPV (and several subsequent surgeries and reinfections), I know exactly where I got it–from my husband. In third-world and Muslim countries it is still the custom that men fool around (normally with prostitutes, as girls are required to undergo confirmation of their virginity by a doctor, or by showing blood on the sheet at marriage) however they want before marriage until around their early 30′s, when most get married. By that time, many are infected with HPV. Thankfully, in America I was getting pap smears every year. I met my future husband one year in June (when we first slept together), and I did not sleep with anyone else. When I had my pap smear the following January/February the pap smear caught “pre-cancerous” changes (I can’t tell you the exact virus numbers off the top of my head, but the doctor pointed out to me that about four certain numbers were the ones causing most of the cancer, and there were two of the high-causing numbers in the reading). He immediately scheduled me for laser surgery, and my husband for treatment.
Now this idea of using the DNA test is a good one if it works even better, but the idea of putting five years between screenings is DANGEROUS. As you can see, and as my doctor confirmed to me at the time, some strains of virus are VERY fast-acting. As you can see, infection with one of the worst viruses can cause
Of course my husband was treated, both with laser, also with pedopholin, in the United States. It was not successful at erradicating the virus spots in my husband (which he said he had had those infected places since his late teens). It did get it under control for a couple years, after many months of treatment, but then we moved to Morocco. The problem returned, and was caught with pap smears here, where I’ve had two or three additional surgeries. My husband was treated with the “freezing” method. It was not successful. So for five years, I have insisted on using condoms with my husband (I already had five surgeries and can’t take any more emotionally) and even though he is depressed, he will not go back for treatments because the treatments are extremely painful for a man. Since he had this problem for many years before getting married, and with prostitutes, my conclusion is that cervical cancer is endemic in Morocco and in many third-world countries where using prostitutes before marriage is still the norm.
I told my doctor here in Morocco that in America, no one is able to get birth control pills without a prescription, and to get that prescription, you have to get a pap smear. That way most women are forced to get them yearly. My ob/gyn thought this was an excellent idea, as here, pap smears do exist, but few women get them, or even come in to be checked until the cancer is well-advanced. Of course birth control pills are sold right over the counter without any prescription.
I will be curious to see what you think about this five-year testing idea now.
Donna
I see I didn’t finish my sentence in the second paragraph. What I meant to say is that certain dangerous strains of the virus are very fast-acting (acoording to my ob/gyn in the United States) and can cause pre-cancerous changes within just a few months. If one were to wait five-years between screenings, the cervical cancer would either be well-advanced by that time, or perhaps the person could even be dead of it by that time!
Donna
Last comment: rereading your post, I was 35 when I met and married my husband.
IF women have been married for five years and BOTH partners are faithful, I wouldn’t see a need for testing except every ten years. But in up to 70 percent of relationships, one partner or the other eventually strays, and it is not always known by the other partner when that happens. For this reason alone, I would say that married women cannot be “safe” to get the test only every ten years. I think doctors should suggest the test, and if the woman has any doubts, she should have the test. But if it is not an obligitory test (as it now is to get birth control pills) many women will skip the test for cost and extra trouble reasons if they don’t see themselves at risk, and some of them will guess WRONG.
Donna
Oh, and last, I’m happy to report the new Guardasil vaccine IS available here in Morocco (my daughter’s pediatrician has a poster up on the wall, AND she mentioned it to us during my teenage daughter’s physical), but the price is the same as in the United States. Mostly only middle-class and above are going to pediatricians anyway. But this price would only be available to the super-rich.
Donna