It’s Time to Eliminate Cervical Cancer through a Combination of Screening and the HPV Vaccine

Our results show increased cross-sectional sensitivity and limited loss of PPV with HPV testing, suggesting that HPV testing can better be applied as the sole primary screening test and that a cutoff for the Hybrid Capture 2 hybridization assay of 2 pg/mL HPV DNA is clearly preferable to the conventional 1 pg/mL threshold.

Guglielmo Ronco, M.D., Ph.D., University of Turin, Italy (Journal of the National Cancer Institute, March 25, 2008)

These data suggest that, when possible, a patient with a normal cytology and initial positive HPV test result should be managed with watchful waiting because a 12-month follow-up can safely exclude more than 50% of infections as transient.

Ana Cecilia Rodriguez, M.D., Division of Cancer Epidemiology and Genetics, National Cancer Institute (Journal of the National Cancer Institute, March 15, 2008)

Our results suggest that, in women aged 30+ years, cotesting with Papanicolaou smear and HPV DNA was more sensitive than reflex HPV testing for the detection of high-grade cervical lesions (91% vs 54%), provided women with a positive hc2 test and negative Papanicolaou test were referred to colposcopy and biopsy.

Janet G. Baseman, Ph.D., Department of Epidemiology, University of Washington (American Journal of Obstetrics & Gynecology, March 2008)

For both vaccinated and unvaccinated women, age-based screening by use of HPV DNA testing as a triage test for equivocal results in younger women and as a primary screening test in older women is expected to be more cost-effective than current screening recommendations.

Sue J. Goldie MD, MPH, Department of Health Policy and Management, Harvard School of Public Health (Journal of the National Cancer Institute, Feb. 26, 2008)

For women who are screened less frequently than recommended, a more sensitive test, such as the HPV test, may prove important. We believe a shift from cellular to viral tests, coupled with education and vaccination, will contribute to a more efficient control of cervical cancer.

Eduardo L. Franco, Dr.P.H., Division of Cancer Epidemiology, McGill University, Montreal, QC (The New England Journal of Medicine, Oct. 18, 2007)

Our data show that implementation of HPV DNA testing in cervical screening lead to a substantial increase in the number of CIN3+ and CIN2+ lesions detected at the baseline screening round. Therefore, our results show that implementation of HPV DNA testing in cervical screening leads to earlier detection of clinically relevant cervical lesions.

C J L M Meijer, Department of Pathology, VU
University Medical Center, Amsterdam, Netherlands
(The Lancet, Oct. 4, 2007)

The HPV Test and Pap are the Best Combination for Screening Women 30+

In 2007, only eight studies and one well-conducted randomized trial are available that allow unbiased evaluation of the accuracy of liquid-based cytology for histologically confirmed CIN 2 or worse. Pooling of these studies indicated that liquid-based cytology is neither more sensitive nor more specific than conventional Pap and these findings were rather consistent over study design, clinical settings, and liquid-based cytology systems.

Marc Arbyn, Unit of Cancer Epidemiology, Scientific Institute of Public Health, J. Wytsmanstreet 14, B150 Brussels, Belgium (Obstetrics & Gynecology, January 2008)

Despite the successes of cytology as a cervical cancer screening method, cytology has a number of significant limitations. Sensitivity using a combination of HPV testing and cytology is significantly higher than that of either test alone with negative predictive values of 99% - 110%.

Thomas C. Wright Jr., MD, Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, New York (American Journal of Obstetrics & Gynecology, October 2007)

Oncogenic HPV infections comprise a significant risk factor for incident cervical abnormalities, and HPV test is a useful adjunct to cytology in detecting the high-risk patients among baseline PAP smear-negative women.

Renata C. Gontijo, Universidade Estadual de Campinas (UNICAMP), Brazil (European Journal of Obstetrics and Gynecology and Reproductive Biology,
Aug. 20, 2007)

Results suggest that HR-HPV test in conjunction with cytology offers clear advantages over single cytology in monitoring the women conservatively
treated for cervical AIS.

Silvano Costa, S. Orsola-Malpighi Hospital, Bologna, Italy (Gynecologic Oncology, May 2007)

The good news is that HPV testing makes cervical cancer screening more sensitive, and routine use of it in appropriate patients will enable us to better stratify a patient’s risk. This will allow us to focus increasingly scarce healthcare resources where they will do the most good – where the real risk is.

Mark S. DeFrancesco, MD, Women’s Health Connecticut (Obstetrical and
Gynecological Survey, 2007)

The HPV Vaccine Won’t Replace the Need for HPV and Pap Screening

Some experts currently would advocate for potentially leveraging HPV testing as a primary screening test, followed by triage with Papanicolau cytologic findings. This alternative strategy would have the added benefit of providing immunosurveilance in vaccinated populations.

Bradley J. Monk, MD, Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange, Calif. (American Journal of Obstetrics
& Gynecology, October 2007)

I tell women that, if you're above 30 and the third-party payer told you that they're only going to pay for one of those two tests, the one you want is the HPV test.

Daron Ferris, MD, professor of family medicine and obstetrics and gynecology at
the Medical College of Georgia in Augusta (American Medical News, Sept. 3, 2007)

Even in the setting of high vaccine coverage, routine screening for cervical cancer will be necessary to detect and treat disease caused by HPV-16 or HPV-18 infections acquired before vaccination and by other carcinogenic HPV types.

Future II Study Group (New England Journal of Medicine, May 10, 2007)

While prophylactic vaccination is likely to provide important future health gains, cervical screening will need to be continued for the whole generation of women that is already infected.

Marc Arbyn and Joakim Dillner, Department of Medical Microbiology, Lund University, Malmo, Sweden (Journal of Clinical Virology, 2007)

Impact of the HPV Vaccine

It's going to be at least a generation before we really see a difference in the way we will conduct business. There's a whole bunch of answers that we don't have about the HPV vaccine. They think the immunity will last, but we know what happened with pertussis. I had whooping cough a couple years ago…

Dina R. Mody, MD, president-elect of the American Society of Cytopathology and director of cytopathology at Methodist Hospital in Houston (American Medical News, Sept. 3, 2007)

Vaccine efficacy for the prevention of the primary composite end point was … 44% (95% CI, 26 to 58) in an intention-to-treat population of all women who had undergone randomization (those with or without previous infection). The estimated vaccine efficacy against all high-grade cervical lesions, regardless of causal HPV type, in this intention-to-treat population was 17%.

Future II Study Group (New England Journal of Medicine, May 10, 2007)