Read Dr. Staub's Perspective

"Had we not incorporated HPV testing into our practice, I feel very certain that her cancer likely would have progressed, and we would not have had the success we did with her treatment."

- Dr. Staub

Dr. Staub's Perspective

Based on extensive supporting data and the latest guidance from the American College of Obstetricians and Gynecologists and the American Cancer Society, my practice decided in December 2005 to order the HPV test along with a Pap for all of our patients age 30 and older. So, during Bette's annual visit that month, I ordered both an HPV and Pap test, informing her about the addition of the new test and the virus it looks for.

When her results came in, both of us were surprised: Her Pap was normal once again, but her HPV test was "positive" (meaning she had a high-risk type of HPV, the virus that causes cervical cancer). Following guidelines, I asked Bette to return six months later for another round of tests, which produced the same result: Pap normal, HPV positive.

I then performed a colposcopy exam to get a closer look at Bette's cervix, which to our even greater surprise revealed severe dysplasia – pre – cancerous cells. To remove these dangerous cells, I performed a cone biopsy (an outpatient surgical procedure in which we cut out the abnormal cells), only to discover that Bette actually had very early-stage cervical cancer.

I was flabbergasted. I really could not believe that a woman who had had so many normal Pap tests could be harboring cervical cancer. To prevent the cancer from spreading further, we scheduled a hysterectomy. Thankfully, neither chemotherapy nor radiation was necessary because we had caught the cancer so early.

The Pap test changed the landscape of cervical cancer prevention, but it isn't always sufficient protection. Bette's situation clearly demonstrates the importance of routine HPV testing for women over 30 to supplement the Pap. Bette had been religious about her annual gynecologic visits. She had not missed a Pap test and they were all perfectly normal for more than 10 years. Had we not incorporated HPV testing into our practice, I feel very certain that her cancer likely would have progressed, and we would not have had the success we did with her treatment.

Like many physicians considering implementing HPV testing for routine screening for all women 30 and older, my colleagues were concerned that a positive HPV result might open up a Pandora's Box of sorts, creating unnecessary anxiety among our patients. In practice, however, the literature and counseling we give our patients prior to their screening is very good at explaining how common HPV is (thus, there is no need to feel stigmatized), how relatively uncommon cervical cancer is (thus, most women who learn they have HPV will not experience any problems as a result) and how successful treatment can be if abnormal cells are caught early through thorough testing. With that education, women who learn they have HPV are thankful for the additional knowledge about their health and know how to react to it.

The bottom line of this story for physicians and women is that Bette's cervical cancer would not have been diagnosed at such an early stage if she had only had Pap tests. With proper counseling prior to administering the HPV test, patients become more knowledgeable about their health and cervical cancer can be better prevented.