Interview on New HPV Testing

Last month, I wrote a feature on the new human papillomavirus (HPV) tests: HPV HR and HPV 16/18.

The HPV tests were recently approved by the FDA, but what does that mean for you? Dr. Michael A. Gold has some answers for you.

Dr. Gold is Associate Professor and Division Director of Gynecologic Oncology at Vanderbilt University Medical Center. He sits on the board of the American Society of Colposcopy and Cervical Pathology and is an active member of many professional societies. He also conducts research in cervical cancer and pre-cancererous abnormalities.

Are HPV tests recommended in addition to Pap smears for some women? If so, why?

Dr. Michael A. Gold: HPV tests are recommended in two situations. First, to help triage a minimally abnormal pap test reported as ASC-US (Atypical Squamous Cells of Undetermined Significance). Only 10% of women with this pap report have a pre-cancererous abnormality known as dysplasia. If high risk HPV testing (testing for the 13 or 14 types of HPV which are at the highest risk for causing cancer or pre-cancer) is performed and is positive, the risk of having a pre-cancererous abnormality increases to 20% and those women are referred on for further evaluation. If the high risk HPV test is negative, the risk is less than 1% of having a pre-cancererous abnormality and those women can be reassured and continued on routine annual screening.

The second situation in which HPV testing is recommended is in conjunction with a pap test for women 30 and older. If both are negative, those women can space future screening out to every 3 years. If the pap smear is normal but the high risk HPV test is positive, they would undergo repeat pap test and high risk HPV in 12 months. If persistently high risk HPV positive, they will then undergo further evaluation.

How will the new tests, HPV HR and HPV 16/18, assist you in better treating patients?

Dr. Michael A. Gold: The new HPV HR (high risk) test is thought to be more accurate than the previous test and so will better determine whether or not a patient is HPV positive. The HPV 16/18 test tests for the two types of high risk HPV (of the 14 types tested for in the HPV HR) that are most likely to cause cervical cancer (approximately 65-75%) and pre-cancererous abnormalities (65%). Currently, this test has been recommended by the ASCCP (American Society of Colposcopy and Cervical Pathology) to be used in women over 30 who have a normal pap test but are high risk HPV positive.

If positive for HPV 16/18, these women are recommended to proceed with further evaluation while those who are high risk HPV positive but HPV 16/18 negative (therefore positive for one of the other high risk types), can repeat a pap test and high risk HPV test in 12 months. Because 25-35% of cervical cancer and pre-cancererous abnormalities are caused by other high risk HPV types besides 16/18, the HPV 16/18 test is not recommended to replace the standard high risk HPV test in either of the recommended situations described above.

When will the new HPV tests become available to patients?

Dr. Michael A. Gold: We anticipate that the HPV HR and HPV 16/18 tests will be available this summer.

Death rates from cervical cancer have fallen since Pap test screening became routine, but thousands of women still die from the disease each year. How can those deaths be prevented?

Dr. Michael A. Gold: Since 1950, the numbers of cases of cervical cancer in the United States have dropped from about 60,000 per year to a plateau of about 11,000 annually. Most of these remaining cases occur in women who have not had a recent pap smear. Continued outreach to rural, elderly, immigrant, and minority populations can increase screening rates and hopefully decrease the incidence further. The HPV vaccine, which includes HPV 16 & 18, will hopefully decrease the number of women being diagnosed with cervical cancer (and will definitely decrease the numbers of women with pre-cancererous abnormalities), but this impact will not be seen for many years.

Do you have anything to add?

Dr. Michael A. Gold: We anticipate a multidisciplinary consensus conference to be held early next year to make other recommendations for use of HPV 16/18 and future type specific testing.

(Image via flickr)