Daily Mail
http://www.dailymail.co.uk/health/article-489133/The-new-cervical-cancer-test-kill-smears.html
The new cervical cancer test that could kill off smears
By JANE FEINMANN
29 October 2007
Should young girls be vaccinated against human papillomavirus (HPV), the sexually transmitted virus that causes cervical cancer?
The Department of Health has agreed to an annual vaccination programme for all girls aged 12 and 13 - and is now considering a "catch-up" programme for older girls.
But parents and religious groups have expressed concerns that the scheme sends a subtle message condoning teenage sex.
Amid the controversy surrounding the vaccine, almost unnoticed has been news that there is a test for the HPV virus itself ? and this test is a highly effective way of detecting cervical cancer.
Not only does the test provide more accurate results, it does so sooner and could mean that women need testing for cervical cancer every six years, instead of every three.
The new test has been approved in the US and is widely provided alongside the smear in many developed countries.
Experts are suggesting that it should be given to women in the UK in addition to having a cervical smear.
The HPV test works by looking for the DNA of the strains of the virus that lead to cancer ? it uses the same cell samples that are taken in the cervical smear but instead of looking for abnormal cells, the DNA test simply assesses whether the woman is HPV-positive.
A growing body of research has shown the benefits of getting this information, particularly in older women.
Last year, Danish scientists who monitored the health of 10,000 HPV-positive women aged over 30 reported that nearly one in five women who have a single HPV-positive test will go on to have cancer within ten years.
A fifth of those who have more than one positive test will develop cancer within three years.
A further trial carried out in the Netherlands and published in The Lancet earlier this month was being hailed by cancer researchers as conclusive proof of the efficacy of the HPV test.
It has shown that having the test along with your cervical smear is 70 per cent more accurate at detecting early signs of the developing cancer than the smear alone.
The researchers, from VU University Medical Centre in Amsterdam, say introducing the test would mean that testing for cervical cancer could be carried out far less frequently ? possibly every six years.
There are suggestions that the HPV test could actually take the place of the routine smear test so that only HPV-positive women would have a cervical smear (a major American study published in the New England Journal of Medicine has shown that the HPV test is much less likely to miss early signs of cancer than the smear).
However, in practice, this would not change the way the cells are collected for examination (both the HPV and smear tests involve using a speculum).
Around 3,000 women are diagnosed with cervical cancer each year ? 1,000 women die annually from the disease.
With scientists predicting it could be at least ten years before the first benefits of a vaccination programme are seen, there are still hundreds of thousands of older women who could benefit from the new HPV test.
Those who back widespread HPV testing say that while it will identify women who are HPV-positive and, therefore, at risk of developing cervical cancer, it will also spare needless anxiety in the seven per cent of women who have a "borderline" smear.
These are women whose cervical cells seem to be changing to cancer but in 99 per cent of cases are not.
"At the moment, women with borderline smears are asked to come back at six-monthly intervals for a repeat smear so that we can watch what happens," explains Albert Singer, professor of gynaecological research at the University of London, who runs a specialist screening clinic at the Whittington Hospital in London.
"It can be an anxious time for women, as many wrongly fear they have a high risk of having cancer.
"Being tested for HPV is reassuring for the majority ? many are told they are clear of cancer, because you cannot have cervical cancer without the presence of HPV."
The test could also be helpful for the 800 or so women who are treated for cervical cancer every year and then have to wait up to ten years to be classed as free of the disease.
"A negative HPV test at 12 and 24 months shows they are cured," explains Professor Singer.
So far, the NHS has no plans to introduce the test routinely ? the policy is to postpone a decision until it has obtained evidence on the value of HPV testing within the setting of UK hospitals.
For those working in the field, this does not make sense.
"The test should have been introduced a long time ago," says Professor Singer.
"It would have saved a lot of anxiety and might have saved lives."
He believes the evidence for its benefits is so clear that "it is only a matter of when it is introduced, not if".
One of the reasons that the NHS has been unwilling to introduce the test is the concern that far greater numbers of women carry the virus than go on to develop cervical cancer.
While a high proportion of young women carry the virus at some point, for the vast majority, it's a short-lived infection because the immune system gets rid of invasion.
Dr Anne Szarewski, senior lecturer at Cancer Research UK's Centre for Epidemiology in London and author of a new book Preventing Cervical Cancer, says: "The important thing is not whether you catch HPV but whether your body fights it successfully and you get rid of it."
By the time women are in their 30s, HPV infection is thought to be less common and more dangerous.
It makes sense, then, to test women from this age.
Despite the apparent benefits of the HPV test, introducing it could prove controversial, suggests Dr Szarewski.
This is because of the potential to raise anxieties in the woman about her sexual past. Because HPV is sexually transmitted, "women frequently blame themselves, or their relationships suffer as accusations fly in both directions," she says.
Yet further research suggests that having the test need not cause such upset, as long as women are properly informed about the virus.
Jo Waller, research fellow and health psychologist at University College London, says: "Information needs to be explicit, with the causes of cervical cancer clearly explained, and that isn't happening."
At the moment, few NHS hospitals offer HPV testing at colposcopy clinics for women who have had a borderline smear.
However, if you are over 30, you can have the test done privately from NHS hospitals or private hospitals with a gynaecology department.
To arrange a test, talk to your GP or practice nurse.
Laboratories charge doctors between £30 and £60 to process the test.
You can self-refer to private hospitals expect to pay upwards of £100 if you have the test privately.