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)

Post from: Blisstree

Interview on New HPV Testing

The new DNA test faces opposition though. Some doctors don’t want to start using it because the annual Pap smear is what brings in patients each year for important check-ups. Plus, old habits are hard to break.

The DNA test still requires cervical scraping, but results are read by a machine. Since the test is more accurate and does not rely on trained pathologists, it may be very beneficial to women in developing countries who can’t get screened as often.

An eight-year study, conducted in India and financed by the Bill and Melinda Gates Foundation, found that a single round of DNA screening for HPV dramatically reduced the incidence of advanced cervical cancer and mortality within eight years. It beat other traditional methods of preventing advanced cancer. The study results were published in The New England Journal of Medicine . (Read the full text online.)

While the DNA test hasn’t yet been accepted as standard of care in the US, how do you feel about being tested less often, but more accurately?

(Sources: The New England Journal of Medicine and The New York Times . Image via stock.xchng. )

Post from: Blisstree

DNA Testing for HPV Could Replace Pap Smear

Approved by the FDA in 2003 for cervical cancer screening in conjunction with a Pap, in women age 30 and older – Digene® HPV Test – is based on proprietary “Hybrid Capture” technology, which combines two innovations from the rapidly evolving field of life sciences – DNA/RNA probes and monoclonal antibodies – to allow rapid, standardized gene testing in virtually any laboratory setting.

Sounds great.

I only have one question: Do most insurance providers in the U.S. cover this HPV test? ( Because I am not based in the U.S, and where I am it probably is too expensive for normal women to afford.)

Greater if they do. Don’t you think?

No offense to the makers or PR people of the Digene® HPV Test, I am just saying that novel tests/screening procedure should be easily accessible to anybody.

Or maybe heads of States should have tests like this subsidized (if not free) to all women?

If Merck can lobby for the mandatory cervical cancer vaccination, why not mandate the cervical cancer screening test (if not already)?

(Is the Gardasil® mandate already reversed?)

Post from: Blisstree

Digene® HPV Test: Only High-Risk HPV Test Approved by the FDA

Dr Elizabeth Davey and colleagues from Sydney University found that using the said technology detected 1.3 more cases of frankly nasty or so-called “high-grade” cervical abnormalities per 1,000 women screened than the conventional manual slide reading.

The ThinPrep Imager would increase detection from 7.7 to 9.0 cases per 1,000 women screened and if introduced more women will not be recalled for repeat smears.

According to Richard Winder, Deputy Director of the NHS Cancer Screening Programmes:

“The ThinPrep Imager (TPI) and other imaging technologies are currently under evaluation and are being assessed for use in the NHS Cervical Screening Programme.”

BBC News has the full report.

Post from: Blisstree

ThinPrep Imager (TPI): A Computerized Cervical Cancer Screening Test

A new large Danish study however, found that a test for human papillomavirus (HPV) is a much more effective way of screening for potential cancer in older women (age 40 and above).

The researchers specifically found that the absolute risk of developing cervical cancer in an older woman who tests positive for HPV is greater than 20 percent within a 10-year period. They also note that most women who test positive for HPV also test negative on a Pap smear given at the same time.

As reported in the November 1 issue of Cancer Research, according to the researchers, the reason is that: HPV infection is both frequent and transient in younger women, and they would often test positive for HPV when no actual risk of cervical cancer existed.

While in order women, HPV infection is rarer and more persistent, putting a woman at substantial risk for the disease before changes in cervical cells (detected by Pap smears) are obvious.

According to the study’s senior author, Susanne Krüger Kjaer, M.D., professor and head of the Department of Virus, Hormones and Cancer at the Danish Cancer Society:

“We have documented that a single HPV test can actually predict older women at risk for cervical cancer better than a single Pap smear can.

Based on these results, we feel that an HPV test would benefit older women, whether or not that test is used in conjunction with Pap smears, or used by itself as an initial screen.”

Find more details from the AACR press release.

Post from: Blisstree

HPV Test, Better Long-term Predictor Of Cervical Cell Abnormalities Than Pap Smear in Older Women