A new study in last week’s New England Journal of Medicine found that the HPV DNA test outperformed pap smears in a large trial of women in India. The results were dramatic – a one time HPV DNA test reduced more deaths and cases of advanced cervical cancer than the traditional pap smear over the 8 year study period. Although the number of deaths in the study were small, roughly 1 per 1,000 in the HPV DNA group and 2 per 1,000 in the control group, that the HPV DNA test can be done as a one-time test has significant advantages, particularly in resource-poor environments such as India.
Whether these new results will change practice in developed countries is still uncertain. The cost-effectiveness of the test depends in large part on the prevalence of HPV in the population. And whether the HPV DNA test means women will no longer need annual pap smears remains controversial. What is clear, however, is that HPV DNA tests will likely be increasingly used, with or without the traditional pap smear.
This story gave lip service to the study, but didn’t give many of the details we just provided in two short paragraphs. No quantification of benefits. No discussion of the possibly limited impact in developed countries.
The story doesn’t mention any harms of the DNA test. The story mentions that women over 30 who get the DNA test would not need to come in for several years before repeating the test. This recommendation is somewhat controversial in that it could potentially disrupt the annual gynecologic visit schedule, which many women rely on as their "regular" health check up. Furthermore, the way in which this information is described is quite confusing – clearly the intention is to advise an annual checkup with cervical cancer screening done only every three years – but this is not well described in the story
The story could have also been improved by describing the costs of the DNA test and it should have quoted at least one expert who was not related to the study or DNA test manufacturer who could have provided more perspective.
The story does not mention the cost of the DNA test.
The story does not quantify the benefits of DNA testing.
The story doesn’t mention any harms of the DNA test. The story mentions that women over 30 who get the DNA test would not need to come in for several years before repeating the test. This recommendation is somewhat controversial in that it could potentially disrupt the annual gynecologic visit schedule, which many women rely on as their "regular" check up. Furthermore, the way in which this information is described is quite confusing – clearly the intention is to advise an annual checkup with cervical cancer screening done only every three years – but this is not well described in the story
The story didn’t give any details of the current study. It did not mention that the study was conducted in India in a resource-poor setting, so there are challenges in applying the same results to the US healthcare system.
The story doesn’t exaggerate the seriousness or prevalence of HPV or cervical cancer.
The story should have quoted at least one expert who was not related to the study or DNA test manufacturer who could have provided more perspective.
The story mentions Pap smears, with or without concurrent DNA testing as the alternative.
It is not at all clear from the story how widely available is the test.
Clearly the DNA test is not new but this is the largest trial to date.
There is no way to know if the story relies on a press release as the sole source of information.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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