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Pap Smear or HPV DNA: Which is More Suitable for Cervical Cancer Detection?

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Pap Smear or HPV DNA: Which is More Suitable for Cervical Cancer Detection?

November 28, 2024 by Fathimah Zahro

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In recent years, the Indonesian government has made various efforts to increase cervical cancer early detection through screening. According to the National Action Plan (RAN) for Cervical Cancer Elimination 2023-2030, the percentage of Indonesian women undergoing cervical cancer screening in 2020 was only 9.35%. This figure increased to 14.5% in 2023, as noted in the Ministry of Health's Indonesia Health Profile 2023 (kemkes.go.id). While this growth is a positive step, it remains far below the WHO's recommended target of at least 70% of women aged 35 undergoing screening and repeating it at age 45.

Early detection plays a crucial role in combating cervical cancer. Cervical cancer often develops slowly and shows no symptoms in its early stages, meaning many women are diagnosed only after the disease has progressed. Early detection helps prevent cancer development by identifying abnormal changes in cervical cells before they become cancerous. WHO recommends that all sexually active women, starting at age 30, undergo regular screenings. This is because cervical cancer develops slowly, and early detection offers a chance for earlier and more effective treatment.
 

Pap Smear Method: A Common Procedure, But Are There Limitations?

The Pap Smear is the most commonly used method for detecting cervical cancer. Its procedure involves the doctor collecting cervical cells to be examined in a laboratory for abnormal changes. Introduced in the 1940s by Dr. George Papanicolaou, the Pap Smear was a groundbreaking innovation that helped reduce cervical cancer mortality rates.

However, despite its widespread use, the Pap Smear is not the most accurate method. It only detects abnormal cells after changes have occurred, serving more as a “warning” than a preventative measure. The Pap Smear also has limitations in sensitivity, meaning some cases of cancer or cell changes may be missed. To ensure early detection, women often need to undergo routine Pap Smears every three years, which requires significant time and financial commitment.
 

HPV DNA: The Latest Screening Method and WHO Recommendation

One of the newest and most recommended methods for early cervical cancer detection is the HPV DNA test. This method identifies DNA from high-risk HPV types, such as HPV-16 and HPV-18, long before abnormal cells develop into cancer. The procedure is similar to a Pap Smear but is more specific and accurate in detecting HPV infections.

WHO recommends HPV DNA testing for its higher sensitivity and because it only needs to be performed every five years, unlike the more frequent Pap Smears. This reduced frequency is due to the HPV DNA test's ability to detect the virus earlier and with greater accuracy, making the results more reliable. Unfortunately, in Indonesia, this method is still not as well-known as the Pap Smear. Limited education and access to this method in various regions are key reasons, although it has been included in the National Action Plan for Cervical Cancer Elimination 2023-2030.
 

Transitioning to HPV DNA Testing

Several studies and developments related to HPV DNA testing are underway in Indonesia. One example is Nusantics, a local biotechnology company that introduced the PathoScan hrHPV qPCR Kit, designed to detect high-risk HPV with high accuracy. This kit offers advantages over conventional methods, including higher sensitivity and the ability to detect 14 high-risk HPV types, such as HPV-16 and HPV-18.

Comparison of Pap Smear and HPV DNA Performance Using PathoScan hrHPV qPCR Kit

Parameter

(Nb: For all parameters, the range is 0–100%,
with a value of 100% indicating the best performance.)

   Pap Smear   

HPV DNA
(PathoScan hrHPV qPCR Kit)

Sensitivity

30-87%

96.55%

Specificity

86-100%

99.87%

PPV

27 - 54%

98.25%

NPV

91 - 96 %

99.75%

 
Source: WHO Guideline ANNEX A Synthesis of Evidence; Pankaj et al., 2018; Clinical Trial Data 2022.
 
Through the table above, we can see a comparison between the performance of Pap Smear and HPV DNA testing, with detailed explanations as follows:
 
  1. Sensitivity (Ability to correctly detect positive cases): HPV DNA using the PathoScan hrHPV qPCR Kit has a very high sensitivity of 96.55%, compared to Pap Smear, which ranges from 30-87%. With higher sensitivity, PathoScan hrHPV qPCR Kit can more accurately detect high-risk HPV infections that could lead to cervical cancer, reducing the risk of missed detection at early stages.
  2. Specificity (Ability to correctly detect negative cases): PathoScan hrHPV qPCR Kit has a very high specificity of 99.87%, meaning the likelihood of false positives is very low compared to Pap Smear.
  3. PPV (Positive Predictive Value): HPV DNA with the PathoScan hrHPV qPCR Kit has a PPV of 98.25%, much higher than Pap Smear.
  4. NPV (Negative Predictive Value): PathoScan hrHPV qPCR Kit has a very high NPV of 99.75%, making it more reliable in confirming individuals without infection, especially in the context of early screening and prevention.
 
The HPV DNA test offers clear advantages over the Pap Smear in terms of sensitivity and screening frequency. Supported by the WHO and governments, as well as innovations from companies like Nusantics, women in Indonesia now have a better option to protect their reproductive health. Early detection is crucial to prevent cervical cancer, and with modern methods like the HPV DNA test, we can reduce the risk of cervical cancer and protect women's health in the future.


 




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