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HPV test more sensitive than Pap, questions remain

Rating

4 Star

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HPV test more sensitive than Pap, questions remain

Our Review Summary

Questions remain – even though a large review was done to try to decide if women should get more than the typical cervical cancer screening, known as a Pap test. This story does justice to the sometimes volatile topic of screening for cancer by laying out carefully what reviewers found when they looked at four different clinical studies comparing different tests for cervical cancer. While the newer techniques may have some advantages in some cases, they are not clearly better at diagnosing cancer early or proven to save lives, according to the reviewers. The story carefully explains the tricky landscape of test sensitivity and why it can lead to the risk of many falsely positive results. It could have done a better job of making clear the options: conventional Pap, liquid-Pap, and liquid-based Pap test plus HPV test (“cotesting”) – and HPV test alone.

 

Why This Matters

The way Pap tests are done has changed a great deal over the past decade, with the advent of new “liquid-based” testing technology that allows concurrent tests for human papillomavirus (HPV). Some strains of HPV promote cervical cancer. Although the HPV test is more sensitive than the traditional Pap smear, its proper role in cervical cancer screening has not been clear. Because screening for cervical cancer is a cornerstone of preventive care for women, it is important to understand how to use these new technologies in ways that provide greatest benefit, while also being mindful of the costs.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

This story does not mention the cost of any procedure, nor does it tackle the societal cost of changes in screening frequency or method.

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

Satisfactory

The story explains the potential benefit, if more-sensitive testing for the virus turns out to prove itself effective in reducing deaths from cervical cancer.

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

Satisfactory

The story explained the impact that false-positive tests might have if the HPV testing became routine. More women could have unnecessary biopsies to remove tissue that was not cancerous.

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

Satisfactory

This story does a sophisticated job of explaining the large review of four clinical trials involving 140,000 women, and why there remain questions that require further study. This researcher’s comment was especially important: “It’s a tricky thing to get your mind around. It may seem that if a test is more sensitive, it must be better. But it’s more subtle than that. You’re trying to make a tradeoff between sensitivity and specificity.”
Evidence from four different trials did not produce a firm conclusion about whether testing women for presence of the human papilloma virus  should become routine.

Does the story commit disease-mongering?

Satisfactory

The story does a good job of describing the rapid drop in cervical cancer rates after introduction of the traditional Pap screening test. The story is careful to point out the not all HPV infections are dangerous, by noting that the immune system usually clears them on its own.

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

Not Satisfactory

There was only a single source quoted –  the lead reviewer and author, Evelyn Whitlock, a senior investigator with Kaiser Permanente in Portland, Oregon.

Does the story compare the new approach with existing alternatives?

Satisfactory

There was great detail in comparing the liquid test and HPV testing with traditional cervical cancer screening.

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

Satisfactory

The different testing methods are all widely available and that can be inferred from the story.

Does the story establish the true novelty of the approach?

Satisfactory

The story states that “a lot of research has been done since the 2003” cervical cancer screening recommendations of the US Preventive Services Task Force, but that there are still questions remaining about the effects of HPV screening.

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

Satisfactory

The story includes reporting beyond any release.

Total Score: 8 of 10 Satisfactory

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