I am 47 years old and for about 30 years I have had a Pap smear once a year. Now for my gynecologist he suggested that I switch to the HPV test, with a three-year term. Can you help me understand the difference between the two exams? And what are the reasons why it would be better to replace one test with the other?
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responds Giorgia Mangili, Head of Medical Oncological Gynecology at the Gynecological Obstetric Clinic of the San Raffaele Hospital in Milan
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Let’s make a premise immediately: the objective of both tests is to identify the predisposing conditions for the formation of a cervical tumor. HPV (papillomavirus) plays a fundamental role in the development of neoplasms affecting the cervix. In fact, papillomavirus infection is the necessary condition for a process of carcinogenesis to begin at the level of the uterine neck, even if the infection alone is not sufficient to determine the onset of a cervical tumor. HPV infection is very common, while invasive cervical cancer is rare, this is because in most cases there is spontaneous regression of the infection. Not all papillomaviruses (there are over 150 different strains) have the ability to induce the formation of a tumor, but only those at high risk, such as strains 16 and 18 which are responsible for the development of 70% of cervical cancers, while the remaining 30% is determined by other viral strains. rare. If the HPV test does not detect the presence of a high-risk HPV infection, the danger of cervical neoplasia is very low.
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What the Pap smear sees
Early diagnosis resulted in a reduction in the frequency and mortality of cervical cancer (and today there is an effective vaccine offered free in Italy to 12-year-old males and females and also in other age groups). Since the 1960s, the pap test has been the most widely used screening test and its spread over the years has allowed a reduction in invasive forms. The pap smear is an exam that can identify pretumor lesions in addition to neoplastic ones. The cytological examination performed on the cells taken during the examination identifies cellular abnormalities at various stages. Various degrees of intraepithelial lesions can thus be diagnosed from low grade (LSIL) which include cellular alterations caused by viral infection or mild dysplastic alteration (CIN1) to high grade lesions (HSIL) which include lesions with medium or severe dysplasia (CIN2 or CIN3), up to the finding of carcinoma cells.
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HPV-DNA test for women after 30
Both are therefore screening tests, the difference that the HPV test allows to identify patients who have an infection potentially at risk of inducing a process of carcinogenesis, while the pap test evaluates if there are cellular alterations induced by the infection. In the plans of the Italian health system, after a cost-effectiveness analysis, cervical cancer screening is being modified by inserting the test for the search for papilloma. The HPV-DNA test should be performed by women after 30 years and only if positive perform further tests, such as colposcopy and biopsy. During colposcopy the vagina and the surface of the cervix are examined under a lighted microscope (colposcope) to check for precancerous lesions or cancer. Often a biopsy is also performed at the same time, i.e. the removal of a sample of cervical tissue to be analyzed in order to determine if dysplasia is present and to establish whether it is necessary to intervene with a more specific treatment.In younger women, the screening test remains the pap test because under the age of 30 although very frequent infection, the clinical impact is less important
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August 17, 2020 (change August 17, 2020 | 09:32)
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