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HPV/DNA Vs. Pap Smear Testing In The Detection Of Cervical Cancer - A Few Questions.

Thursday, April 09, 2009
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A newer, low cost version of a molecular HPV DNA test is being promoted as the next best screening tool for cervical cancer among women older than 30yrs of age, especially in developing countries. In fact the results of a recent study conducted in India and financed by the Bill and Melinda Gates Foundation, are being heralded by experts as the harbinger of things to come - they show that this test is better than the pap smear in preventing advanced cervical cancers and deaths due to the same. Negative results indicate that a patient need not come in for screening again for another three years at least, thus obviating the need for a yearly pap smear.

It has been argued that while this test may not become popular in the developed countries, due to an established  mind set of gynecologists and the population in general regarding the yearly pap smear, it can be a handy alternative to pap smears in developing countries. This is especially true since in developing countries many technicians and doctors may lack adequate training in how to read pap smears and as a result cases often go undetected.

Having said this though I have the following questions:
1.  Yes, this test is automated and hence does not require technician training, but it will require equipment. How expensive is the equipment? How feasible will it be to use it at the grass root level in developing countries where resources are scarce. What about the logistics of setting up labs with the equipment in the rural areas? Is it any more feasible than the pap smear?
2.  It is contended that pap smears require a patient to return for results and follow up- how is this different with the HPV DNA test? While a negative test result allows a patient to go screening free for three years, a positive test will require confirmation with a pap smear and usual follow up.
3.  Most women who are sexually active will test positive for HPV - but the infection usually is self limiting, so where does that leave a person who has gotten a positive result? In fact they could possibly be over treated!
4.  If the test results are positive, the person will be treated, but...
        a.  Treatment is expensive and maybe unnecessary
        b.  Treatment has side effects e.g. it can increase chances of premature deliveries

I feel that while there may be merit in using this test in developing countries, in the end it will not be any better or worse than the other tests already available. Is it a genuine alternative - perhaps not, but it could be a genuine solution when used in conjunction with other tests to -  screen, detect and prevent cervical cancer, both in the developed and the developing world.

References:
1.    Sankaranarayanan R, Nene BM, Shastri SS, et al. HPV screening for cervical cancer in rural India. N Engl J Med 2009;360:1385-1394.
2.    Mark Schiffman, Sholom Wacholder: From India to the World A Better Way to Prevent Cervical Cancer. N Engl J Med 2009 360: 1453-1455
3.    Curt Malloy, Jacqueline Sherris, Cristina Herdman. HPV DNA Testing: Technical and Programmatic Issues for Cervical Cancer Prevention in Low-Resource Settings.  http://screening.iarc.fr/doc/HPV-DNA-Testing-Issues.pdf
4.    Andrew Pollack. Pap Test, a Mainstay Against Cervical Cancer, May Be Fading. Published: January 16, 2007 http://query.nytimes.com/gst/fullpage.html?res=9A05E7DA1030F935A25752C0A9619C8B63&sec=&spon=&pagewanted=2
5.    Donald G. McNeil Jr. DNA Test Outperforms Pap Smear. Published: April 6, 2009 http://www.nytimes.com/2009/04/07/health/07virus.html?emc=eta1

By, The Dietetic Team @ NutritionVista.com

Related Topics: Cervical Cancer, Can It Strike Really Young Women?

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20 July, 2010 | Vijayalakshmi | Reply

Vijayalakshmi Hello Krithika
An annual physical examination, mammography and pap smear test are sufficient screening techniques to ensure that you detect breast cancer and cervical cancer in the early stages (if at all you get it, God forbid) and begin treatment early to nip it. Also be aware to report any loss in weight or unusual finding to your GP if and when they do occur. Ensure you eat a diet rich in anti oxidants and exercise regularly to keep fit.
Please do not live with the anticipation that you will also get Breast cancer but at the same time be cautious and have regular check ups and all will be well.
Thank you

20 July, 2010 | Krithika | Reply

Krithika My mom had breast cancer, she survived for 10 years after the surgery and the last two years were horrible, she suffered a lot. I just get mammography done every year, is it necessary for me to get the overall check for cancer?

07 June, 2010 | Kanika Jain | Reply

Kanika Jain Very true, as mentioned in the article, it needs to be seen whether this test can work alone or would give an overall correct picture only when used with other related tests.

regards
Kanika Jain
Dietitian
NutritionVista

20 July, 2010 | Sangeetha Narayana Swamy | Reply

Sangeetha Narayana Swamy Dear Krithika,

You have not mentioned the stage of the cancer and if it had metastasized to the other parts of the body. Generally if there is a strong family history of cancer, it is advised to get a complete health check up done every year, starting from the age of 30 years.

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