2018-09-11

Goodbye to the Pap-test: the new HPV Test for Papilloma virus arrives

Goodbye to the Pap-test: the new HPV Test for Papilloma virus arrives

The famous "Pap-test" is being replaced throughout Italy by the innovative "HPV Test", more effective and sensitive in detecting the papilloma virus, responsible for 99.9% of diagnoses of cervical cancer. In reality, the Pap-test or Papanicolau Test, named after the Greek American naturalized physician Georgios Papanicolau who invented it, is not intended to retire anyway; it will be "retroceded" to second line screening for all those women who will be positive for the HPV Test, by virtue of its greater specificity in detecting pre-cancerous lesions caused by the virus. In practice, it will be used as a precision instrument where necessary, as stated to ANSA by Professor Basilio Passamonti, president of the Italian Cervicocarcinoma Screening Group (Gisci): "The two integrated tests represent the maximum possible guarantee for prevention: the HPV-Test, which is more sensitive, identifies women with ongoing infection, while the Pap-test, which is more specific, should be done at a later stage to detect any injury due to cell modification caused by the virus".

HPV and cervical cancer

The HPV virus is the necessary cause of cervical cancer: it is the first cancer recognized by the World Health Organization as being totally attributable to an infection. In 2008 Prof. Harold Zur Hausen won the Nobel Prize for this discovery made in 1976. Today, thanks to a long study and national and international research, Italian screening programs are gradually adopting the HPV test instead of the Pap-test, as a new screening test for the prevention of this cancer. Screening with HPV tests, offered to women aged 30-35 years, together with the anti-HPV vaccination offered to girls in their 12th year of life, makes it possible to improve the fight against this disease.

The regions concerned

According to the National Prevention Plan 2014-18 of the Ministry of Health, by this year all regions should have included the Hpv test as the primary examination for women between 30 and 64 years. However, according to the National Screening Observatory, by the end of 2017 only Emilia Romagna, Piedmont, Veneto, Tuscany, Umbria and Basilicata had done so. Among the regions at a good stage - according to Ons President Marco Zappa - there are instead Abruzzo, Valle d'Aosta, Campania, Lazio, Liguria, Lombardy, Molise and Trento. "Sicily and Calabria have just started, while Friuli, Marche, Puglia, Sardinia and Bolzano have not started". However, Italy is "among the most advanced countries in the world, and among the European countries, only the Netherlands is at our level," he explained.

Why HPV testing is done every 5 years

The HPV test identifies a woman's risk of having an injury well in advance of the Pap-test, so it is possible to do the test less frequently, which is to lengthen the time between one HPV test and the next. The lengthening of the screening interval is therefore not due to reasons of savings or cuts in health care that we hear so much about during this period, but is due to the fact that the HPV test is a more protective, sensitive and safe test than the previous one. In the Netherlands, the screening interval with HPV tests is even seven years. That's why it's no less safe for women to go from three years to five years between tests than to do a pap-test every 3 years.

Participation in screening and HPV testing is important, as is following the recommendations on the frequency of screening. Gynaecologists and general practitioners are informed of this change, if you have any doubts you can talk about it with them.

What happens if the HPV test is positive?

Women who have a positive HPV test response are controlled until the infection disappears. The presence of HPV infections in women is quite frequent and should not worry.

When the HPV test is positive, a pap-test is also performed from the same sampling as the HPV test to see if the HPV virus has already caused any initial changes in the cells.

Only women whose Pap-test triage presents alterations (which does not mean having a tumor) will be invited to take an examination called Colposcopy which is a thorough examination and allows you to see the neck of the uterus with a special tool called a colposcope. For more information on colposcopy, the document on Information Materials of the second level of screening is available on the GISCi website.

If the triage pap-test is negative, i.e. shows no cellular abnormalities, the woman will be invited to perform a new HPV test after one year. Most of these infections regress spontaneously within 12 months, and only women who still have a positive HPV test for persistence after one year will be invited to make a Colposcopy.

Lucia Franco

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