Nav: Home

HPV vs. Pap test for cervical cancer screening: Strong evidence calls for new protocols, say experts

February 06, 2017

Amsterdam, NL, February 7, 2017 -- For many years, cytology has been the established method used for cervical cancer screening. Commonly known as the Pap test, cytology and its regular use in yearly exams has been credited with significantly reducing the number of deaths from cervical cancer. Evidence now shows that sexually transmitted human papillomavirus (HPV) infection is almost always responsible for cases of cervical cancer with two HPV types responsible for 70% of all cases. Many members of the health care community are now calling for a shift in screening procedures to reflect our improved understanding of cervical cancer development. In a special issue of Preventive Medicine, experts look at the emerging evidence that HPV screening may be a better way than Pap tests for doctors to screen for cervical cancer. They also address the difficulty of implementing such a change in different parts of the world based on available resources or public health priorities.

"Whether in conventional or automated forms, Pap cytology has been a core technology in medicine and public health; that is until it was firmly established that cervical cancer was the long-term consequence of persistent infection with a specific sexually transmitted infection. It has since become clear that testing for the causal agent, HPV, can bring substantial improvements and efficiency to cervical cancer screening," remarked Preventive Medicine Deputy Editor Gayle A. Shinder, PhD, Department of Oncology at McGill University. "The above transition in technologies serves at the backdrop for this special series of articles and commentaries."

The issue presents in-depth coverage of the scientific evidence supporting the transition from cytology to HPV testing, along with reasons why policy around cervical cancer screening is so context specific. The contributors to this issue endorse that HPV testing offers a better way to screen for cervical cancer, but also acknowledge that changes to screening paradigms cannot be made in a vacuum, based only on scientific findings.

As Guest Editor for the special issue, Mark Schiffman, MD, MPH, Senior Investigator in the Clinical Genetics Branch at the National Cancer Institute, NIH, Bethesda, MD, wrote, "HPV testing is coming and the role of cytology will be reduced; however, this collection of evidence summaries, guidelines, and editorials aims to illustrate the variety of ways the changeover will occur globally. More broadly, this special issue illustrates the importance and limits of epidemiology as the 'basic science of public health.' The conclusion is that given an established epidemiologic set of scientific facts and validated prevention tools, real-life concerns that vary by region will determine which public health strategies are used."

Dr. Schiffman's straightforward editorial touches on the potentially controversial elements of HPV testing as a primary screening method for cervical cancer. "It turns out that detailed implementation of HPV primary screening to replace cytology reveals many choices reliant on value judgments and not risk assessment, particularly when resources are limited," said Dr. Schiffman. "Controversial areas include acceptable costs and effort, choices of safety and action thresholds, and the role of the clinician in the integration of test data vs apps and guidelines."

This special issue highlights the evidence for supporting the switch from cytology to HPV testing, contrasted with regional responses. Two reviews address the efficacy and specificity of HPV testing, along with providing possible triage methods to help clinicians identify the highest risk patients. Another study uses HPV vaccine data to make the case for phasing out first-line cytology and replacing it with HPV testing.

In addition to the studies, the special issue also features five commentaries focusing on how different approaches to health care and levels of available resources around the world are set to influence this change in screening protocols. They address how these changes would affect various parts of the world based on their existing health care systems, the values of those systems, and the available medical resources in different areas.

The special issue is designed to help facilitate a meaningful conversation about evidence-based best practices for cervical cancer screening in many different parts of the world and to begin to look at the challenges associated with implementing such a shift. "I believe that, among experts, there is an emerging consensus that HPV testing is theoretically the optimal available primary screening testing, but that optimal implementation is far from settled," concluded Dr. Schiffman. "As different strategies are applied worldwide, the hope is that they will be translatable and represent different societal conclusions sharing a jointly-understood scientific base."
-end-


Elsevier Health Sciences

Related Public Health Articles:

Public health guidelines aim to lower health risks of cannabis use
Canada's Lower-Risk Cannabis Use Guidelines, released today with the endorsement of key medical and public health organizations, provide 10 science-based recommendations to enable cannabis users to reduce their health risks.
Study clusters health behavior groups to broaden public health interventions
A new study led by a University of Kansas researcher has used national health statistics and identified how to cluster seven health behavior groups based on smoking status, alcohol use, physical activity, physician visits and flu vaccination are associated with mortality.
Public health experts celebrate 30 years of CDC's prevention research solutions for communities with health disparities
It has been 30 years since CDC created the Prevention Research Centers (PRC) Program, currently a network of 26 academic institutions across the US dedicated to moving new discoveries into the communities that need them.
Public health experts support federally mandated smoke-free public housing
In response to a new federal rule mandating smoke-free policies in federally funded public housing authorities, three public health experts applaud the efforts of the US Department of Housing and Urban Development to protect nonsmoking residents from the harmful effects of tobacco exposure.
The Lancet Public Health: UK soft drinks industry levy estimated to have significant health benefits, especially among children
The UK soft drinks industry levy, due to be introduced in April 2018, is estimated to have significant health benefits, especially among children, according to the first study to estimate its health impact, published in The Lancet Public Health.
Social sciences & health innovations: Making health public
The international conference 'Social Sciences & Health Innovations: Making Health Public' is the third event organized as a collaborative endeavor between Maastricht University, the Netherlands, and Tomsk State University, the Russian Federation, with participation from Siberian State Medical University (the Russian Federation).
Columbia Mailman School Awards Public Health Prize to NYC Health Commissioner Dr. Mary T.
Dr. Mary T. Bassett, Commissioner of the New York City Department of Health and Mental Hygiene, was awarded the Frank A.
Poor health literacy a public health issue
America's poor record on health literacy is a public health issue, but one that can be fixed -- not by logging onto the internet but by increased interaction with your fellow human beings, a Michigan State University researcher argues.
Despite health law's bow to prevention, US public health funding is dropping: AJPH study
Although the language of the Affordable Care Act emphasizes disease prevention -- for example, mandating insurance coverage of clinical preventive services such as mammograms -- funding for public health programs to prevent disease have actually been declining in recent years.
'Chemsex' needs to become a public health priority
Chemsex -- sex under the influence of illegal drugs -- needs to become a public health priority, argue experts in The BMJ this week.

Related Public Health Reading:

Introduction to Public Health
by Mary-Jane Schneider (Author)

The Health Gap: The Challenge of an Unequal World
by Michael Marmot (Author)

Public Health: A Very Short Introduction (Very Short Introductions)
by Virginia Berridge (Author)

Public Health: What It Is and How It Works
by Bernard J. Turnock (Author)

A History of Public Health
by George Rosen (Author), Elizabeth Fee (Introduction), Pascal James Imperato (Introduction)

Public Health Nursing: Population-Centered Health Care in the Community, 9e
by Marcia Stanhope RN DSN FAAN (Author), Jeanette Lancaster RN PhD FAAN (Author)

The Public Health Crisis Survival Guide: Leadership and Management in Trying Times
by Joshua M. Sharfstein (Author)

Introduction To Public Health
by Mary-Jane Schneider (Author)

101 + Careers in Public Health, Second Edition
by Beth Seltzer (Author)

Public Health 101: Healthy People―Healthy Populations
by Richard Riegelman (Author), Brenda Kirkwood (Author)

Best Science Podcasts 2018

We have hand picked the best science podcasts for 2018. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Why We Hate
From bullying to hate crimes, cruelty is all around us. So what makes us hate? And is it learned or innate? This hour, TED speakers explore the causes and consequences of hate — and how we can fight it. Guests include reformed white nationalist Christian Picciolini, CNN commentator Sally Kohn, podcast host Dylan Marron, and writer Anand Giridharadas.
Now Playing: Science for the People

#482 Body Builders
This week we explore how science and technology can help us walk when we've lost our legs, see when we've gone blind, explore unfriendly environments, and maybe even make our bodies better, stronger, and faster than ever before. We speak to Adam Piore, author of the book "The Body Builders: Inside the Science of the Engineered Human", about the increasingly amazing ways bioengineering is being used to reverse engineer, rebuild, and augment human beings. And we speak with Ken Thomas, spacesuit engineer and author of the book "The Journey to Moonwalking: The People That Enabled Footprints on the Moon" about...