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DNA tests replace Pap smears?

Rating

2 Star

DNA tests replace Pap smears?

Our Review Summary

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.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not mention the cost of the DNA test.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story does not quantify the benefits of DNA testing.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

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

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

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.

Does the story commit disease-mongering?

Satisfactory

The story doesn’t exaggerate the seriousness or prevalence of HPV or cervical cancer.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

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.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story mentions Pap smears, with or without concurrent DNA testing as the alternative.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

It is not at all clear from the story how widely available is the test. 

Does the story establish the true novelty of the approach?

Satisfactory

Clearly the DNA test is not new but this is the largest trial to date.

Does the story appear to rely solely or largely on a news release?

Not Applicable

There is no way to know if the story relies on a press release as the sole source of information.

Total Score: 3 of 9 Satisfactory

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