Research proves greater effectiveness of HPV test for detecting cancer

The application of the DNA-based HPV test for cervical cancer screening is more effective in detecting the disease. Research carried out by the State University of Campinas (Unicamp) proved the effectiveness of the test in Brazil. The comparison is with the Pap smear, which identifies cells that are already sick. The detection of cancer in women who took the DNA-HPV test was brought forward by ten years, still in its early stages.

The study was carried out in partnership with the Municipality of Indaiatuba (SP) from October 2017 to March 2020, covering more than 80% of the target population. The city had the highest health informatization index and the Unified Health System (SUS) card in the region of Campinas. The first results were published in November in the scientific journal The Lancet Regional Health – Americas.

Júlio Cesar Teixeira, principal researcher of the study and director of Oncology at the Women’s Hospital (Caism) at Unicamp, says that Pap smears reached only 30% of the target women. “We went from coverage, which was 30%, to over 90% and we used a more sensitive and efficient test. What happened? In two and a half years, we detected 21 cases of cancer in the population, 14 of which were microscopic”, he added. The average age was 39 years.

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In comparison with the previous program, which used the Pap test as a preventive exam, 12 cancers were detected and only one was microscopic, the others were advanced. The average age of these cases was 49 years. “With the new test, we detected the cancers that would emerge in the next ten years in the city. We already detect it in early stages, with cure chances close to 100%”, explains Teixeira.

Under the program, 86.8% of the tests were negative and 6.3% had an indication for colposcopy. “You screen these people. Who has the virus, I’ll look at the second test, which could be cytology [Papanicolau] or looking directly at the cervix, with a colposcopy, which is an exam like a magnifying glass to see if she already has any pre-cancer lesions. You end up detecting it before becoming a lesion in many women”, says the researcher.

Teixeira explains that the HPV vaccine, which began to be applied in Brazil in 2014 and is aimed at children and adolescents aged 9 to 15 years, should reduce the circulation of the virus, making tracking by cytology difficult. “Through the vaccine, they will have much less changes, because they will have much less HPV. So, the Pap smear will not be able to detect anything in this future population, it will have to be an HPV test”.

The study developed by the Faculty of Medical Sciences at Unicamp was able to prove the effective cost of replacing the test. Despite the higher initial cost, Teixeira explains that some factors make the total cost lower. Cytology exams, for example, need to be done every three years, and the HPV test is done every five years. “A negative HPV test guarantees five years of zero risk for having a major disease, so you space it out further.”

In addition, there are treatment costs when the diagnosis is made late. “If you detect a pre-cancer lesion, a woman lives her entire life. If it detects cancer, it has a risk of dying and shortening its life, depending on the stage”, he exemplifies. The doctor adds that the cost of treating an advanced cancer and a microscopic one is at least 20% higher.

HPV

According to the National Cancer Institute (Inca), cervical cancer is caused by persistent infection with some types of the Human Papillomavirus – HPV. “Practically out of every ten people in their lifetime, eight have contact with HPV in their genitals. There are several types, and 14 are related to cancer”, explains the researcher.

Aside from non-melanoma skin cancer, cervical cancer is the third most frequent malignant tumor in the female population. And it is the fourth cause of death in women from cancer in Brazil. In 2020, there were 16.7 thousand new cases. In 2019, there were 6,500 deaths, according to the Atlas of Mortality from Cancer.

Teixeira emphasizes that this is a cancer that can be eradicated, given that the causative agent, the HPV virus, is known.

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