HPV test, not Pap smear is priority, experts urge

Cancer Care Ontario says it should be first screening tool

HPV testing should replace the Pap smear as the first screening procedure for cervical cancer for women over 30, recommends Cancer Care Ontario, which is working with the province to change the long-standing practice. In what has proved controversial in the U.S., Cancer Care Ontario says DNA testing for human papillomavirus (HPV), which causes almost all cervical cancers, is preferable because it is more accurate, patients can go longer between screenings and it leads to fewer cervical cancer deaths. In the States, drug maker Roche is asking the Food and Drug Administration for approval for the genetic test, which has been around for years, as the go-to option for doctors. However, several American women’s patient groups worry the DNA test is more costly and more complicated than the Pap smear, and could lead to confusion. “They’re dead wrong when they say this is a radical shift,” said Dr. Joan Murphy, of Toronto’s University Health Network, about warnings from the U.S. groups.

In 2012, Cancer Care Ontario published guidelines recommending HPV testing as the first test.

“You can’t get cervical cancer if you don’t have an HPV infection, so looking for the infection is best,” said Murphy, who leads the cervical screening program for Cancer Care Ontario.

As well, with Pap smears and other cell-based testing, “cells can look abnormal even in the absence of HPV infection.”

Using HPV testing first, if something abnormal is found, a Pap smear would follow and the same specimen could be used, Murphy said.

Currently, HPV testing is not funded in Ontario. Murphy said Cancer Care Ontario is working with the Ministry of Health now to “make the case this is better for women, economically viable,” Murphy added. “It’s not going to save money, but it’s not going to cost a lot more.”

Currently in Ontario, women under age 21 are not screened for cervical cancer, and after that every three years with a Pap test if they are or have been sexually active.