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HPV test beats Pap for cervical cancer screening
Question of the Day
However, if an HPV test was positive, a Pap test helped confirm or rule out the need for follow-up.
The study didn’t look at the downside of HPV testing _ how many false alarms and needless procedures it triggered. HPV tests cost $80 to $100 compared to $20 to $40 for Paps.
The prostate study sought a better way to use PSA tests, which are troublesome because PSA can be high for many reasons besides cancer, and doctors don’t know which cancers need treatment or whether screening saves lives. Most groups don’t recommend PSA tests, but most men over 50 get them anyway.
The new study “is not going to end the controversy, but it suggests a very interesting middle ground,” Lichter said.
Researchers at Memorial Sloan-Kettering Cancer Center in New York used stored blood samples that 12,000 Swedish men gave for a heart study decades ago, when most were 44 to 50 years old. They also had second samples from some of them six years later, and samples from other 60-year-old men.
Looking 27 years later, researchers saw that 44 percent of cancer deaths occurred in men whose initial PSAs had been in the top 10 percent when they were 44 to 50 years old.
Conversely, scoring below the median meant very little cancer risk years later.
“They’re identifying a group of guys who don’t need to be screened, or need to be screened less often,” said Dr. Otis Brawley, the cancer society’s chief medical officer.
The results are “provocative,” but this type of study can’t prove that screening prevents deaths, said Dr. Matthew R. Smith of the Massachusetts General Hospital Cancer Center. Few of the Swedish men were treated for prostate cancer as most men are today, which can affect survival.
The National Cancer Institute, the Swedish Cancer Society and several foundations paid for the work, and one researcher holds patents for two PSA-related tests.
Baseline PSA tests for men in their 40s can’t be recommended yet, Brawley said. The cancer society says men should be informed of the risks and benefits of PSA tests starting at age 50, and sooner for blacks and those with family history of prostate cancer.
The government-funded ovarian cancer study involved nearly 80,000 women. Half were screened annually with an ultrasound for four years and a blood test for six years. The blood test looked for CA-125, a substance often elevated in ovarian cancer.
After 13 years, there were no major differences in ovarian cancers found or deaths from the disease. Screening found only 212 cancers while giving 3,285 false alarms that led to 1,080 unneeded biopsy surgeries and 163 serious complications.
“So many people say `how can cancer screening be harmful?’ This thing documents it,” Brawley said.
The results don’t apply to using these tests on women with symptoms of ovarian cancer or abnormal physical exams. That’s still the best way to check for ovarian cancer in those cases.
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