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Groundbreaking Study Could Make Cervical Cancer Detection Easier - 2002-05-09

Cervical cancer is the leading form of cancer death among women around the world. One reason is the test to detect the illness, called the Pap smear, misses a large percentage of cases. But two studies appearing in this week's Journal of the American Medical Association report that if the Pap test was combined with another test, diagnosis of cervical cancer could be dramatically improved.

The Pap test misses on the order of 15 to 50 percent of pre and early cancers. A Pap smear is a test to see whether surface cells at the mouth of the womb are likely to become cancerous.

Experts believe the human papilloma virus, or HPV, causes cervical cancer, a sexually transmitted disease that often has no symptoms.

A study by lead researcher Dr. Jeanne Mandelblatt of Georgetown University in Washington, D.C. concludes that adding a test for the papilloma virus, or HPV, to the Pap smear may save even more lives.

"We think the study is very groundbreaking. It's the first time we've shown in a U.S. population that testing for papilloma virus can be as good if not better than Pap smear in certain circumstances. We've also shown that adding the papilloma testing to Pap smears will improve our detection of cervical cancer in this country and save more lives at a reasonable heath care cost," Dr. Mandelblatt said.

But testing for HPV is experimental and costly at this point, especially the way Dr. Mandelblatt proposes; namely giving it to every woman that gets a Pap smear.

Researcher Sue Goldie doesn't think an HPV test is necessary for every woman, only those who's Pap tests come back abnormal. In another study published in the same issue of Journal of the American Medical Association, Dr. Goldie and colleagues found the HPV test to be cost effective.

"A strategy where you did an HPV test in a woman with this abnormal test result would prevent about half or more of these women from having to undergo a colposcopy. And you could tell more than half of those women, approximately half, that they were not at any higher risk than any other woman. And they could go home and could go home to a normal regular, preventive screening schedule," she said.

A colposcopy is a more invasive form of screening where a doctor looks close up at the cervix with a form of magnified glasses and snips pieces of tissue, which are sent to a lab for examination.

While both studies are based on health care in the United States, Dr. Goldie says 90 percent of cervical cancer cases are in the Third World, where the Pap test has not worked well in detecting the disease.

As a result, Harvard University's Sue Goldie and others are looking into HPV testing for women in the developing world.

"There has been a lot of discussions with the makers of the HPV tests over what type of new type of HPV test could be made that could be cheaper and maybe give a more rapid result, which would be ideally what we need in places like sub-Saharan Africa or Haiti. So, it's a very promising and exciting area, but it absolutely has to be lower in price," she said.

A test for human papilloma virus costs around $10. But Dr. Goldie said it would have to cost a lot less, around $4 per test, to make it affordable for most countries.