Newly Approved DNA Test for HPV Could Replace Your Pap
Could a DNA test for HPV replace the need to have a Pap test? Our experts weigh in.
Most women would rather avoid a Pap test that isn’t necessary — and now they can. Recently, the FDA approved the HPV DNA test that can be used as a stand-alone test without a Pap smear. This test, which has been approved for women age 25 and older, gives your gynecologist another tool for diagnosing cervical cancer. The test was approved by the FDA in April, but has been available for several years.
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The Pap test has been an extremely valuable cancer-screening tool. With that test in use, cervical cancer is no longer one of the leading causes of death in women. Also, using the Pap test, physicians learned an important fact: The human papillomavirus (HPV) causes approximately 99 percent of cervical cancers.
The HPV DNA test can be an alternative to the Pap test because it provides a highly effective screening device to identify the presence of HPV, which is a sexually transmitted virus. If no HPV is detected, a Pap test is not necessary.
“With the DNA test, we can detect the virus,” says gynecologist Robert DeBernardo, MD. “We can also sort those viruses into two categories: high-risk ones that are associated with cancer, and low-risk ones that are not associated with cancer but with warts or other mild pre-cancer changes.”
The HPV DNA test (known as the cobas HPV test) is a diagnostic procedure that uses a small plastic spatula- or broom-shaped instrument to collect material from the cervix and vagina. The sample of cervical cells collected for the test allows doctors to identify 14 high-risk types of HPV, including HPV 16 and HPV 18.
Should these high-risk types be detected, your gynecologist will recommend a colposcopy procedure. This involves a more detailed examination of the cervical cells. However, if the test identifies any of the other more than 100 types of less harmful HPV, your gynecologist will typically then recommend a Pap test to decide whether you need a colposcopy.
“If there’s not any high-risk virus found in the DNA test — which is significantly more specific for pre-cancer changes than a Pap test — then the likelihood of having a pre-cancer condition is very low,” Dr. DeBernardo says. “When a woman does not have a high-risk virus detected, this predicts that for the next three years, she is very unlikely to have any pre-cervical cancer changes.”
About 14 million people become newly infected with HPV each year, according to the Centers for Disease Control. In the past, because the virus was so prevalent, doctors only recommended HPV testing for women who were 30 or older.
However, the highest occurrence of cervical pre-cancer happens in patients between ages 25 and 29. So, the FDA decided the benefits of the test would be more far-reaching if they began testing women at age 25.
The FDA approval of the HPV DNA test does not change the cervical cancer screening guidelines or recommendations for Pap smears. However, women over 25 can choose this screening method over the Pap smear, if they prefer.
One concern, Dr. Bernardo says, is that women will not have the Pap test administered as frequently if the DNA test only needs to be administered every three to five years.
“The Pap test is important because it brings people to the doctor,” he says. “We sometimes pick up other problems on that Pap test that will be missed if we are just doing an HPV test every three to five years.”
The best advice, Dr. DeBernardo adds, is to discuss all of the screening options with your physician to determine which is best for you.