HPV test more effective than traditional Pap, but there's a caveat

A test for oncogenic human papillomavirus (HPV) alone or combined with a conventional Pap smear can detect cervical intraepithelial neoplasia with a higher sensitivity than the Pap smear alone, according to two studies published in the Oct. 18 issue of the New England Journal of Medicine.

In the first study, Marie-Helene Mayrand, MD, from McGill University in Montreal, Canada, and colleagues performed HPV testing and conventional Pap testing in 10,154 women (aged 30 to 69 years) to identify high-grade cervical intraepithelial neoplasia. They found that HPV testing had a sensitivity of 94.6% compared with 55.4% for Pap testing and a specificity of 94.1% compared with 96.8% for Pap testing.

In the second study, Pontus Naucler, MD, PhD, from Lund University in Malmo, Sweden, and colleagues randomly assigned 12,527 women (aged 32 to 38 years) to either an HPV test plus a Pap test or a Pap test alone. They found that 51% more women receiving both tests were found to have high-grade cervical intraepithelial neoplasia or cancer. At later screening tests, women receiving both tests had 42% lower rates of high-grade intraepithelial neoplasia or cancer, suggesting that the addition of the HPV test reduced the incidence of cervical cancer.

Mayrand MH, Duarte-Franco E, Rodrigues I, et al. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007;357:1579-1588.

Naucler P, Ryd W, Törnberg S, et al. Human papillomavirus and Papanicolaou tests to screen for cervical cancer. N Engl J Med. 2007;357:1589-1597.