HPV Testing for Primary Cervical Cancer Screening

MedicalResearch.com Interview with:

Matejka Rebolj, PhD King’s College London, London, UK

Dr. Rebolj

Matejka Rebolj, PhD
King’s College London, London, UK

Henry Kitchener, MD FRCOG FRCS University of Manchester, Manchester, UK

Dr. Kitchener

 

Professor Henry Kitchener, MD FRCOG FRCS
University of Manchester, Manchester, UK

 

MedicalResearch.com: What is the background for this study?

Response: We now have reliable and affordable technologies to detect human papillomavirus (HPV), a virus which is universally accepted as the cause of cervical cancer. Various large trials confirmed that cervical screening could be improved by replacing the smear (cytology) test that has been in use for decades, with HPV testing. Many countries are now making the switch. In England, this is planned for the end of 2019. To test how to run HPV testing within the English National Health Service, a pilot was initiated in 2013 in six screening laboratories. We also wanted to determine whether the encouraging findings from the trials could be translated to everyday practice. This is important not only because we will be using different HPV tests, but also because women undergoing screening in trials are much more selected than those who are invited to population-based screening.  Continue reading

Self Sampling for Cervical HPV: Useful Screening Tool

MedicalResearch.com Interview with:

Prof. J. (Hans) Berkhof PhD Vrije Universiteit Amsterdam 

Prof. Berkhof

Prof. J. (Hans) Berkhof PhD
Vrije Universiteit
Amsterdam 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: In most countries, the Pap test is used for cervical cancer screening but recently several countries have switched from Pap testing to HPV testing.

Like the Pap test, the HPV test requires a cervical sample to be taken by a clinician. Vaginal self-sampling is also used, but only in underscreened women. We know that self-sampling increases screening participation in underscreened women and it is likely that many women that attend screening also prefer self-sampling if it had been offered to them.

We studied whether an HPV self-sampling test is an accurate alternative to a regular HPV test in women invited for routine screening. We randomized about 14,000 women, invited for screening, to self-sampling or clinician-sampling. Women with a positive HPV test result also received the other HPV test.

We found that the HPV self-sampling test yielded similar performance as the regular HPV test for detection of cervical pre-cancerous lesions (CIN3 and CIN2).  Continue reading

Dual Stain More Accurate & Efficient for Detecting Cervical Precancers in HPV-Positive Women

MedicalResearch.com Interview with:

Megan Clarke, PhD, MHS Cancer Prevention Fellow Clinical Genetics Branch Division of Cancer Epidemiology & Genetics National Cancer Institute Rockville, MD 20892

Dr. Clarke

Megan Clarke, PhD, MHS
Cancer Prevention Fellow
Clinical Genetics Branch
Division of Cancer Epidemiology & Genetics
National Cancer Institute
Rockville, MD 20892 

MedicalResearch.com: What is the background for this study?

  • Infection with high-risk human papillomavirus (hrHPV) is the primary cause of cervical cancer. While hrHPV infection is common, most infections are benign and clear on their own without causing cervical cancer. However, some women develop persistent hrHPV infections and are at risk for cervical cancer and its precursors (i.e., precancer).
  • The United States Preventative Services Task Force recommends screening every 3 years with cervical cytology (i.e. Pap) alone, every 5 years with hrHPV testing alone, or with a combination of hrHPV testing and cytology (co-testing) for women aged 30 to 65 years.
  • Screening with hrHPV testing is highly sensitive for detecting cervical precancer but requires additional triage tests to identify HPV-positive women at high-risk of developing cancer who should undergo colposcopy (visualization of the cervix) and biopsy from those at low-risk who can be safely monitored.
  • Currently, Pap cytology is recommended as a triage test for women testing HPV-positive, but this approach requires frequent re-testing at short intervals because the risk of cervical precancer is not low enough in HPV-positive women who test cytology negative to provide long-term reassurance against future risk. In most settings, women who test HPV-positive, cytology-negative are referred to repeat screening within one year.
  • The p16/Ki-67 dual stain assay is a molecular test that measures two specific proteins, p16 that is strongly linked with hrHPV infection, and Ki-67, a marker of cell proliferation that is common in precancers and cancers.
  • Studies have shown that the dual stain test has greater accuracy for detecting cervical precancers in HPV-positive women compared with cytology.
  • In order to determine the optimal screening intervals for the dual stain test, long-term prospective studies are needed to determine how long HPV-positive women who test dual stain negative can be safely reassured of a low precancer risk.

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Almost 5 Million Unnecessary Pap Smears Done Annually In Women With Hysterectomy

MedicalResearch.com Interview with:

Fangjian Guo, MD, PhD Assistant Professor BIRCWH Scholar Department of Obstetrics & Gynecology Center for Interdisciplinary Research in Women’s Health The University of Texas Medical Branch

Dr. Fangjian Guo

Fangjian Guo, MD, PhD
Assistant Professor
BIRCWH Scholar
Department of Obstetrics & Gynecology
Center for Interdisciplinary Research in Women’s Health
The University of Texas Medical Branch

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: National guidelines consistently recommend against cervical cancer screening among women with a history of a total hysterectomy for a benign condition. These women are unlikely to develop high-grade cervical lesions. The goal of our study was to assess whether these guidelines are being followed. We examined the use of Pap testing among US adult women with a history of total hysterectomy for a benign condition and the roles of health care providers and patients in the initiation of Pap test use.

We found that in 2013, 32% of women who have had a hysterectomy received an unnecessary recommendation for cervical cancer screening from a health care provider in the past year; 22.1% of women with hysterectomy received unnecessary Pap testing. Although the majority of Pap tests were performed at a clinician’s recommendation, approximately one fourth were initiated by patients without clinician recommendations. According to standard 2010 US Census population figures, about 4.9 million unnecessary Pap tests are performed annually among women who have had a total hysterectomy for a benign condition. At approximately $30 per test, $150 million in direct medical costs could be saved annually if screening guidelines were followed for these women.

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