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 The new guidance is not universally accepted by all major medical
organizations. However, the document does give some direction to
doctors who may use the HPV test for screening, says lead author Dr.
Warner Huh, from the Society of Gynecological Oncology and the
American Society for Colposcopy and Cervical Pathology.
The HPV test has been approved by the U.S. Food and Drug
Administration - but even more important than getting FDA approval
"is getting accurate information to providers so they can understand
the approach,” said Huh.
About 12,000 U.S. women were diagnosed with cervical cancer in 2010
and about 4,000 died from the disease, according to the Centers for
Disease Control and Prevention.
Roughly 91 percent of cervical cancers are thought to be caused by
HPV.
At present, both the HPV test and the Pap test involve scraping
cells from a woman’s cervix and vagina to be sent for testing. A Pap
test looks for abnormal cells that may be pre-cancerous. The HPV
test, on the other hand, checks for the presence of the virus.
Last summer, a study found that the HPV test is better than the Pap
test at assessing whether women are at risk for cervical cancer (see
Reuters Health story of July 18, 2014 here: http://reut.rs/1xJEDou.)
In that study, women were less likely to develop cervical cancer in
the three years after a negative HPV test than after a negative Pap
test.
The new guidance, which is based on a review of 11 studies, suggests
that women first be screened with an HPV test at age 25. If the test
is negative, they should not be screened for another three years.
If the HPV test is positive for HPV strains 16 and 18, the ones most
likely to lead to cancer, it should be followed by a biopsy of the
cervix.
If the women test positive for other strains of HPV, they should
receive a Pap test, according to the guidance, which is published in
Gynecological Oncology and two other medical journals.
For women younger than age 25, the new guidance says they should
follow the current recommendation for Pap testing.
In 2012, the government-backed U.S. Preventive Services Task Force (USPSTF)
recommended that women between ages 21 and 65 years be screened
using a Pap test every three years and said those ages 30 to 65
years could instead opt for cotesting, which is a Pap test in
combination with a HPV test, every five years.
The American College of Obstetricians and Gynecologists (ACOG) had a
representative among the authors of the new guidance, but ACOG still
supports its existing recommendation, which mirrors that of the
USPSTF.
Huh said one of the major concerns is that screening women with the
HPV test in their 20s leads to unnecessary further testing because
so many people in this age group will test positive for a strain of
the virus.
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HPV is the most common sexually transmitted infection and affects
both men and women. About 79 million people are infected but most
don’t know it because symptoms are uncommon and the virus usually
clears on its own.
“We think the balance of procedures and diseases are justifiable,”
said Huh, who is also an expert on gynecologic oncology at the
University of Alabama in Birmingham.
Dr. George Sawaya and Miriam Kuppermann write in an editorial
published in Obstetrics and Gynecology that the possible harms of
HPV screening reach beyond additional testing.
For example, women may be left with unexplained test results. Or,
they may told of results showing abnormal cells that are destined to
clear up on their own.
“Such surveillance recently has been found to be associated with
significant psychological distress in 39 percent of women,” they
write.
Dr. Brent DuBeshter, director of gynecologic oncology at the
University of Rochester Medical Center in New York, also questioned
the use of HPV testing among younger women.
“Because it’s so common and disease is so uncommon in that age
range, you wouldn’t think it’s a very good age range for that,” said
DuBeshter, who wasn’t involved in the new guidance.
In his opinion, DuBeshter added, HPV testing will eventually
overtake Pap tests for cervical cancer screening, but it’s hard to
know when, because change in medical practice is usually slow.
Huh said a HPV test costs roughly $48. That is comparable to a Pap
test, according to DuBeshter.
Including a biopsy, during a procedure known as colposcopy, Huh said
there are now three ways for women to be screened for cervical
cancer. He emphasized that it’s important for women to be screened.
“These options become completely irrelevant if women don’t come into
to be screened,” Huh said.
SOURCE: http://bit.ly/1tOs7Pu
Gynecologic Oncology, online January 8, 2015.
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