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Tuesday, February 18, 2014

Which Is Better: Normal Pap or Negative HPV Test?

The Danish Cancer society the MERMAID 2 project has been looking in to a woman's risk of pre-cancer or cancer of the cervix based on whether they have high risk (HR) or low risk (LR)  HPV on a test. They also want to compare risks from women with normal pap vs women with negative HPV test. They found that negative HPV is a better predictor of having no cervical cancer in the next decade. Low risk HPV infection of the cervix has been shown to be associated with mild precancerous changes, but has never been shown to predict cancer or progression to carcinoma in situ or CIN III, the most advanced cervical pre-cancer. Thus the publications from the MERMAID 2 project and others have stopped endorsing testing for the low risk types of the HPV virus. Generally women getting a pap test have about a 1/100 risk for CIN III over the next decade. For women with Low Risk HPV there was only 1.7% risk vs 1.1%, over the 8 years of the study. So only about 1/2% difference in pick up of high grade disease; with many extra women being captured for testing who will never have serious risk. This is why these authors strongly urge not to est for low risk HPV. In contrary For women with high risk HPV on their pap, they have a risk of 17.4% of developing the CIN III or greater, or the high grade pre-cancer or greater (cancer itself), in the next decade. If patients had both the HR and LR they had only 15.9% chance of getting significant prec-cancer. This data on 35,000 women's pap smear fluid indicated that having a normal pap is not as reassuring as having a negative HPV test. So ask your gyno if you have had HPV testing, or if this testing may be right for you.

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