The Medical Services Advisory Committee has recommended a new test for human papillomavirus, or HPV, to replace Pap smears from 2016. Women would have their first screening for cervical cancer at 25 and would be tested only every five years.
The Pap smear and the HPV test both consist of a cervical swab. But unlike the Pap smear, which checks for abnormalities in cells taken from the cervix, the HPV test pinpoints whether a patient is infected with one of 16 high-risk HPV subtypes — including two genotypes that are said to be responsible for over 70 percent of cervical cancer cases.
The test which detects the presence of the human papilloma virus is predicated on the basis that HPV causes cervical cancer. However direct causation has not been proven: In a controlled study of age-matched women, 67 per cent of those with cervical cancer and 43 per cent of those without were found to be HPV-positive.
Cervical cancer is not a big killer of women. In Australia there are about 740 cases of cervical cancer each year and around 270 deaths from the disease. Mortality rates generally increase with age with the highest number of deaths occurring in the 75-79 age group. Less than 6 per cent of cervical cancer deaths occur in women under 35 years of age.
To test for the presence of HPV is problematic for most of the adult population has been infected with HPV at some time or other and the greater majority of us do not develop cervical cancer. No doubt this test will reveal many cases of HPV necessitating unnecessary procedures such as cervical biopsy, a procedure which may cause complications during future childbirths. With the focus on HPV as the primary cause of cervical cancer, cases of non-HPV cervical cancer will most likely be missed such as those caused by factors such as smoking, environmental toxins and ageing.
This test is a recommendation at present, but already supporters such as the Cancer Council Australia’s chief executive, Ian Olver are proclaiming its efficacy and safety, so it’s adoption would seem assured. But remember Gardasil, the HPV vaccine, also promoted as a safe and necessary vaccine for young girls, boys and women, but responsible for at least 162 deaths and over 32,000 adverse events. New tests and procedures must be questioned. We must find out who benefits, and in the HPV equals cervical cancer story, it’s definitely not women.