Cervical cancer: HPV, life-changing tests for those over 30

More precise screening, results that last longer and an examination fully reimbursed by health insurance. The prevention of cervical cancer – more than 3,000 new cases and 1,000 deaths each year in France – took a big step forward in 2020 with the generalization of HPV (human papillomavirus) tests, the solution now favored for patients. women aged 30 to 65. Almost ten years after its last recommendations, the Haute Autorité de Santé (HAS) recommends that people over 30 use these tests instead of a classic cytological examination during a primary screening for cervical cancer. ‘uterus. The detection technique changes, not the sample (smear). And its cost, between 40 and 50 euros, is now covered for all women.

Directly scan for virus

“With the PCU (cervico-uterine sample), the cells are placed in a fixing fluid and, until then, the product was sent for pathological anatomy in order to be able to do a cytological examination. From now on, he will go directly to the virology laboratory to extract the DNA from the cells and do an HPV test to look for the expression of the papillomavirus ”, explains Professor Jean-Luc Brun, gynecologist at the Bordeaux University Hospital and vice-president of the French Society of Gyneco-pathology. We no longer look for abnormalities in the cells but directly for the virus. In those under 30, nothing is changed: in this age group, the papillomavirus is a very widespread family of viruses that does not however trigger infections of the cervix. It would therefore be pointless to seek it out.

Wider support

The advantage of HPV testing? They are much more reliable: their negative predictive value is around 100%. “When I say to a woman, ‘Madam, you are negative’, I am telling her the truth. Whereas before I could have been wrong with the 40% false negatives by saying that the cytological test was normal while it was not ”, explains Dr Brown. Another advantage: these tests make it possible to space out the controls. Every five years vs. every three years previously. What to have peace of mind longer. “This will kind of free about 85 to 90% of women after 30 years who are HPV negative, from screening too early and this will allow the 10-12% who are HPV positive to target a population more or less. at risk to take care of them in the most appropriate way», Analyzes the Dr Joseph Monsonego, gynecologist specializing in pathologies linked to the papillomavirus. Before recalling that a positive HPV test in a person over the age of 30 does not necessarily mean that there is a risky or precancerous lesion to take care of.

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This new technique is implemented by health professionals and supervised by cancer screening management centers at the territorial level. A method «important» since it allows a wider support, according to the Dr Monsonego, but which raises a number of challenges: the list of recommendations to be respected is long. “We must prevent this from leading to unnecessary examinations, overtreatment or even overdiagnosis based solely on knowledge of a positive HPV test”, he underlines, calling for vigilance.

Aurore Savarit-Lebrère


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