The study results showed that the human papillomavirus test is more sensitive than the widely used but often flawed method of performing a regular Pap smear, and several experts are predicting a strong push to replace Pap smears with simple HPV testing.
Suboptimal specificity of the HPV test is still a limiting factor for widespread adoption of the test as a cancer screening tool, write the authors of the editorial, "especially among populations of young women who often carry HPV infections that regress without oncogenic effect".
But HPV testing is thought to have a lower specificity for CIN2+ than cytology screening, which could result in more colposcopies and biopsies being performed - some of which may be unnecessary, says the author of a related but separate JAMA editorial.
"In the USA, co-testing is now the recommended gold standard, and neither doctors nor their patients should be willing to give up the added benefit you get from screening with a Pap test and HPV test together", he says. The control group had the traditional Pap test for their initial screening, while the test group had primary HPV screening - a test that looked for more than a dozen specific types of HPV most likely to cause precancerous lesions in the cervix. Most sexually active adults contract HPV at some point, but it is usually cleared without problems.
A new study published in the Journal of the American Medical Association could change that recommendation.
HPV testing also can be done on samples of vaginal and cervical secretions that clinicians or women themselves gather with a swab - a less invasive process than the Pap.
More women were referred for colposcopy after HPV tests at the start of the study: 57 per 1,000 women compared with 30.8 per 1,000 women after smear tests - but the reverse was true at 48 months. Since then, the conventional test was replaced by a liquid-based Pap cytology test, but now it seems that it might be replaced by a different test: the Human papilloma virus test (HPV test).
"This information will help inform future cervical cancer screening guidelines and continue to decrease deaths from this preventable disease", added Schmeler, who was not involved in the study.
Major driving factors for the growth of this market include, increasing prevalence of cervical cancers, increasing demand for advanced cancer diagnostics, increasing awareness about technological advancements in cancer testing and aging population. The Pap smear has been around for 50 years, so co-testing remains a viable option, Wright said. "This trial. found primary HPV testing detected significantly more CIN3+ and CIN2+ cases in the first round and significantly reduced CIN3+ and CIN2+ rates 48 months later".
Pap smears involve scraping cells from the cervix and examining them for cancerous changes, also known as "cytology" testing.
The Task force states that for women aged between 29 and 65 HPV tests alone every five years can be the only screening test.
Of note, the Canadian Task Force on Preventative Health Care differs from the US task force - it recommends Pap smear screening every three years between ages 30 and 69, citing weak evidence for screening women ages 25 to 29.
The study included patients from 2008 to 2012, and nearly half of them were tested using the HPV test. The other group was tested using the Pap test and returned after two years and four years for rechecks.
Most cases are preventable with screening the best way of catching it before it develops.
"This supports the small, but significant benefit of co-testing".
The trial showed the HPV test provides "better detection earlier" of the people at risk "that we really need to be following more closely", Durand said.