Cervical cancer: What are the benefits of HPV tests for cervical screening?

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Pap tests aren't the only way to screen for cervical cancer. HPV tests can be used for this purpose too. They are actually even more effective at detecting abnormal tissue that could turn into cancer.

Cervical cancer (cervical carcinoma) is a type of cancer that grows at the opening of the cervix, which is found at the bottom of the womb. About 4,600 women get cervical cancer in Germany each year. Cervical cancer develops from a long-term with human papillomaviruses (HPV). If the viruses stay in the cells lining the cervix for a long time, then the cells can change over time, and eventually develop into cancer after many years. The vast majority of HPV infections, though, are not dangerous and clear up on their own.

Screening tests for cervical cancer

Cervical cancer doesn't cause any symptoms at first, or only very few, so it is often not detected for a long time. If women have symptoms such as frequent vaginal bleeding between periods, the cancer might already be quite advanced. The goal of tests is to detect cell changes (dysplasia) early enough for them to be treated successfully before cancer has a chance to develop.

Pap tests (also called smear tests) have been used to screen for cervical cancer in Germany since the 1970s. This test involves examining cells on the cervix to detect any changes. In Germany, statutory health insurers pay for women between the ages of 20 and 34 to have a smear test once a year. From the age of 35, women are offered a combined test that includes a smear test and a test for certain human papillomaviruses (an HPV test) every three years.

The HPV test can be done to find out whether a woman has an HPV and is therefore at greater risk of cervical cancer. But the HPV test can't detect abnormal cell changes. For this reason, if the HPV test shows that a woman has an HPV , she will have to have a Pap test and perhaps other tests too.

Research on the benefits of HPV tests

Several large studies have compared HPV tests with Pap tests to see what advantages they have in cervical . The studies looked into whether HPV tests are better at detecting high-grade dysplasia (abnormal cells that have changed a lot) and preventing cervical cancer. A total of more than 235,000 women participated in the six studies. HPV tests were used in very different ways in these studies. For example, sometimes they were used instead of Pap tests, and sometimes they were used in addition to Pap tests. In the studies, both of the tests were carried out every three to five years. This is different to the situation in Germany, where Pap tests are offered once a year.

HPV tests could have benefits in cancer screening

The results of these studies show that HPV tests are more effective than Pap tests at discovering high-grade dysplasia (abnormal cells that are likely to turn into cancer). Individual Pap tests fail to detect half of all cases of dysplasia. HPV tests help to detect a lot more cases.

If Pap tests and HPV tests are carried out regularly over a long time period, both detect most areas of abnormal cells. But HPV tests were slightly more effective overall: Fewer women who had HPV tests developed cervical cancer. The studies lasted about five years. This is what was found during that time:

  • About 4 out of 10,000 women developed cervical cancer if they only had Pap tests.
  • About 1 out of 10,000 women who had HPV tests (in addition to, or instead of, Pap tests) developed cervical cancer.

But the studies didn't allow any conclusions to be drawn about whether women who had an HPV test were less likely to die of cervical cancer.

HPV tests can also have disadvantages. Many abnormal cells don't develop into cervical cancer. This means that, compared to Pap tests, HPV tests might also be more likely to detect abnormal cells that would never have developed into cancer. This kind of is of no benefit to women and might mean that they end up having unnecessary treatment, such as surgery to remove tissue from the cervix (conization). Abnormal cells usually return to normal on their own, especially in women under the age of 30.

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Benefit assessment of HPV test in primary screening for cervical cancer. Final report; Commission S10-01. 2011.

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Benefit assessment of an HPV test in primary screening for cervical cancer. Update; Rapid Report; Commission S13-03. 2014.

Melnikow J, Henderson JT, Burda BU et al. Screening for Cervical Cancer With High-Risk Human Papillomavirus Testing: A Systematic Evidence Review for the U.S. Preventive Services Task Force (AHRQ Evidence Synthesis No. 154). 2018.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on September 7, 2021
Next planned update: 2024

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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