The Case for PAP-HPV Co-testing: A Conservative Approach is Warranted and More

The Pap test has been the most successful screening method for the prevention of cervical cancer with a seventy per cent decrease in its death rate since 1950. This is in the face of the sexual revolution of the 1960’s occasioned in part by the introduction of the birth control pill in 1960. The subsequent change in sexual mores and increased promiscuity should have resulted in an increased incidence and death rate from cervical cancer. In fact the detection of cervical intraepithelial neoplasia (CIN) increased dramatically and its subdequent treatment resulted in successful cancer prevention.

A recent study of cervical cancer screening among 256,648 women has supported the superiority of Pap HPV contesting. Of the 526 cancers detected, HPV testing alone would have missed 18.6% and cytology alone 12.2%. Although this study involved Digene Hybrid Capture and not the Roche Cobas test, there were a surprising number of HPV negative cancers, especially among adenocarcinoma. Although more sophisticated HPV analysis might reveal some of the tumors to be HPV related, false negative HPV tests are sufficiently common to undermine its role as a primary testing method. The practice implications of these recent studies is that cotesting is the more sensitive approach overall. Read more>>>>>>>>>>>>>>