NEW YORK – A new study from Quest Diagnostics and the University of Pittsburgh Medical Center found that cotesting with both the human papilloma virus screening test and Pap testing is more likely to detect cervical cancer than HPV screening alone.
The study, published Wednesday in the American Journal of Clinical Pathology, assessed the sensitivity rates of HPV testing alone, liquid-based cytology Pap testing alone, and HPV and Pap testing together in detecting precancer and cervical cancer in almost 19 million test results from 2010 to 2018. False negatives from cotesting were about 13 percent, whereas false negatives from Pap testing were 26 percent and HPV testing were 28 percent, the study found.
The liquid-based cytology Pap tests performed included Hologic's ThinPrep and Becton Dickinson's SurePath, and positive results were defined as all results with epithelial cell abnormalities at or above the level of atypical squamous cells of underdetermined significance. HPV tests included Qiagen's Digene Hybrid Capture 2 HPV test for DNA and Hologic and Gen-Probe's Aptima HPV test for messenger RNA.
In addition, cotesting detected more women who developed biopsy-confirmed adenocarcinomas, a more aggressive type of cervical cancer. Cotesting identified 82 percent of the cancer cases, while HPV testing caught 61 percent and Pap testing caught 60 percent. The non-detection rate for women screened by HPV test alone within a year of a cancer diagnosis was nearly 23 percent compared to 15 percent from Pap alone and 6 percent from cotesting. Abnormal test results decline as the time before cervical cancer diagnosis increases, the study found, likely due to smaller lesional size and increased difficulty in sampling infected lesional cells.
Combining the tests also detected more women who developed biopsy-confirmed precancers, with 96 percent of those precancers detected by cotesting compared to 93 percent by HPV screening and 78 percent by Pap test.
One limitation of the study, authors noted, was that it only looked at women who sought medical care and were referred to laboratory services at Quest. A previous study from Quest published in 2015 in Cancer Cytopathology found HPV-only cervical screening would have missed about 19 percent of women who developed confirmed cervical cancer.