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DNA-based test may clarify murky Pap smear results

Saturday March 30, 2013
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In women who have a potentially or mildly abnormal cervical smear, using a DNA-based test can identify those at higher risk of having precursors of cervical cancer, according to a data analysis.

In a report published March 28 on the website of the Cochrane Library, researchers found the DNA-based test identified patients in possible need of treatment more accurately than a repeat smear test.

Cervical smear tests are carried out to identify women who might be at high risk of developing cervical cancer, according to background information in the study. Cells collected in the smear test are examined under the microscope. If abnormalities are seen, a patient may be asked to undergo further tests to determine whether the abnormalities are serious and whether treatment of pre-cancer is required.

Sometimes the cells examined from the smear are not clearly normal or abnormal (referred to with the acronym 'ASCUSí or 'borderline nuclear changesí), whereas other types of cells identified are only mildly abnormal (referred to as 'LSILí or mild dyskaryosis). The main cause of cervical cancer is the human papillomavirus, although only a small number of women who carry the virus go on to develop cervical cancer. The Hybrid Capture 2 assay is a DNA-based method that tests for DNA from those strains of the virus that are higher risk for cervical cancer.

The authors compared the HC2 test with a repeat conventional smear test as a way of prioritizing possible cases of cervical pre-cancer. They reviewed 39 studies involving a total of 13,196 women. Compared with a repeat smear, the HC2 test more accurately identified women with pre-cancer.

"Based on these findings, the HC2 test can be recommended as a way of triaging women with an ASCUS smear," Marc Arbyn, the studyís lead researcher who is affiliated with the Scientific Institute of Public Health in Brussels, said in a news release.

However, the HC2 test overstated the risk of pre-cancer in women with LSIL abnormalities, leading the researchers to conclude that more specific tests are needed to triage women with LSIL.

"The use of the HC2 test in women with LSIL abnormalities in their smear test results should be carefully considered," Arbyn said. "It may be more accurate in older women with these abnormalities, but it is important to take into account the local cost of further, more invasive tests and to avoid unnecessary referrals and anxiety."

The study abstract is available at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008054.pub2/abstract.


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