HPV Vs. PAP test- Special review of Canadian views in honor of Canada day!
What is the best test for early detection of cervical cancer? Pap Test or HPV Test? This question is on the mind of healthcare professionals in Canada. The number of women who have cervical cancer in Canada has reduced by 69% since implementing regular screening with Pap tests. But still, every year 1550 women are diagnosed with Cervical Cancer in Canada, and 400 die of the disease. Pap test is a cytological test- an examination of cells under the microscope in order to understand the state of an organ or tissue. Canadian healthcare recommends women from the age of 21 to 70 to get tested every 3 years.
CADTH, a non-profit that provides information for Canadian health care decision makers, recently published a report that examines thoroughly if HPV screening would be a more effective method for early detection of cervical cancer. HPV, the Human Papilloma Virus is considered to be the major cause of cervical cancer. The virus has over 100 types, 40 of them are connected to causing warts, infections and Cancer. Out of these, 13 are correlated to cancer, the most commonly types found in cervical cancer patients are type 16 and 18, and after those 31,33, 45, 52 and 58. HPV is also connected to other types of cancer, such as anal cancer, penile cancer, cancer of the mouth and throat, and cancer of the vagina and vulva. HPV typing is a test that identifies DNA or RNA of the virus, also diagnosing which type is present. Hence it's accuracy.
The problem with HPV test is that it could make the number of women who are tested positive to HPV and are send to an unnecessary colposcopy test grow. On the other hand, HPV is found to identify patients who need-follow up more accurately than a Pap test. CADTH recommendations were not absolute about replacing the Pap test with the HPV typing, although they brought a lot of evidence that shows the efficiency and advantages of the HPV test. All the same, they were very adamant about the importance of getting tested regularly!
Another conclusion is that more research needs to be done, one that was already published is a research by Dr. Gina Oglivie from Canada research, University of B.C and B.C Women's hospital, showing that HPV screening was more effective in detecting abnormalities in the cervix cells than the traditional Pap test. Dr. Oglivie's work has prompted Federal Minister of Health, Ginette Petitas Taylor to grant Dr. Oglivie 10 million dollars towards further research of early detection of cervical cancer and HPV vaccination.
The problem is that 1/3 of the population aren’t tested at all, or not regularly, due to various reasons, such as living in rural areas, or because of the inconvenience of the test. One of the solutions is using self-test-kits that women can use in the privacy of their homes. The other is rising awareness, and of course more research, improving the understanding and implementing of prevention, early detection and vaccination of cancer of the cervix and the main precursor, HPV.
In the Uk, (which Canada is celebrating today's independence from…) the National Health Service (NHS) has announced that all cervical screening will be done by HPV test, and only positive tests will be sent for further cytology examination. This transformation is to be completed by the end of 2019.
Happy and healthy Canada day from L.E.M lab Israel !
- HPV Testing for Primary Cervical Cancer Screening: Recommendations Report. Ottawa: CADTH; 2019 Mar. (CADTH Optimal Use Report; vol. 7, no. 1c).
- Edmonton Journal, Pamela Fireman, June 5, 2019, edmontonjournal.com/uncategorized/staff/health-blogs/medicine-matters/federal-health-minister-announces-10-million-for-cervical-cancer-research/wcm/17827827-86a0-4ed8-8492-4dffe6541a6b
- IBMS Institute of Biomedical Science, June 27, 2019, ibms.org/resources/news/hpv-primary-screening-update/