March 4, 2007

New York Times Examines Future Use Of Pap Test For Cervical Cancer Prevention As HPV Tests, Vaccine Become More Widespread

The New York Times on Tuesday examined how the Pap test might "start to fade in importance" for cervical cancer prevention as genetic tests to detect human papillomavirus, which causes most cases of cervical cancer, are beginning to "play a bigger role in screening." In addition, as more women receive Merck's HPV vaccine Gardasil, less precancerous lesions will be detected, making the Pap test more costly for each cervical cancer case that is detected, the Times reports. Because Gardasil does not protect against all HPV strains known to cause cervical cancer, screening is still necessary. The Pap test, which detects abnormal cervical cells that could become cancerous, has been the "mainstay of cervical cancer prevention" since the 1950s. According to the Times, the Pap test has reduced cervical cancer rates by 75% or more in countries with high screening rates. The HPV test -- which FDA approved in 1999 to follow up on abnormal Pap tests and to use in conjunction with the Pap test in women ages 30 and older -- might be more accurate at detecting abnormal cells than the Pap test, the Times reports. The Pap test detects precancerous lesions 50% to 80% of the time, while the HPV genetic test, which screens for DNA of the 13 HPV strains that cause cervical cancer, detects 90% of precancerous lesions and produces fewer "ambiguous" results, according to the Times. Many experts have said it would be more cost effective to make the HPV test the primary test to screen for cervical cancer. Some experts are concerned wider use of the HPV test would lead to increased detection of lesions that are not cancerous, causing more women to undergo unnecessary biopsies and procedures to remove lesions, according to the Times. The HPV test costs between $50 and $100 to administer, compared with $20 for Pap test. About 10,000 cases of cervical cancer cases are diagnosed each year in the U.S., and about 4,000 U.S. women die annually of the disease. More than half of cervical cancer cases are in women who have now been screened (Pollack, New York Times, 1/16).

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