HPV testing could be future strategy for primary screening for cervical cancerDecember 04, 2003
Authors of a UK study in this week's issue of THE LANCET propose a new approach for cervical cancer screening. Testing for the human papilloma virus (HPV)-the main cause of cervical cancer-could be the primary screening tool, with cytology reserved for women who test positive for HPV.
HPV testing (by genetic analysis) of cervical smears is known to be more sensitive than conventional cytology for detecting pre-malignant cervical cells called high-grade cervical intraepithelial neoplasia (CIN2/CIN3); however HPV testing is less specific than cytology (ie. it produces more 'false-positive' results). HPV testing as a primary screening approach is only feasible if appropriate management is given to women who are HPV-positive with negative or borderline cytology results.
The HART (HPV in Addition to Routine Testing) study was led by Jack Cuzick and colleagues from Cancer Research UK. Around 11,000 women aged 30-60 years from 161 GP practices in 5 UK regions participated in the study between 1998 and 2001. Women with borderline cytology and women positive for high-risk HPV with negative cytology were randomised to immediate colposcopy (detailed examination of the cervix) or to surveillance by repeat HPV testing, cytology, and colposcopy at 12 months.
HPV testing was more sensitive than borderline or worse cytology (97% compared with 77%) but slightly less specific (93% compared with 96%) for detecting malignant cells. Surveillance at 12 months was as effective as immediate colposcopy for women with minimal abnormalities, i.e., those women with either borderline cytology results (regardless of HPV status) or who were HPV positive but had negative cytology results.
Jack Cuzick comments: "HPV testing could be used for primary screening in women older than 30 years, with cytology used to triage HPV-positive women. HPV-positive women with normal or borderline cytology (about 6% of screened women) could be managed by repeat testing after 12 months. This approach could potentially improve detection rates of CIN2/CIN3 without increasing the colposcopy referral rate."
In an accompanying Commentary (p 1866), Eduardo Franco from McGill University, Montreal, Canada, concludes: "The HART trial can be viewed as a launching pad for future randomised trials that will assess the duration of protection conferred by a negative HPV result and the efficacy of a Pap-centered triage approach. A paradigm change, if necessary, will represent far more than a technicality. It will mean that cervical cancer screening will shift from a morphology-based approach to one in which the search for a sexually transmitted virus becomes the focus of disease detection. Clients and providers will have to learn to live with the new paradigm, one which places the emphasis of prevention not only on women but on their partners as well. It is about time."
Cancer Research UK Press Office
Professor Eduardo L Franco
Departments of Epidemiology and Oncology
Montreal, Quebec H2W1S6, Canada
Issue 6 December 2003
Lancet 2003; 362: 1866, 1871-76
Related Cervical Cancer Articles:
A new review looks at cervical cancer screening in the era of HPV vaccination.
Duke University researchers have developed a handheld device for cervical cancer screening that promises to do away with uncomfortable speculums and high-cost colposcopes.
While current guidelines indicate that cervical cancer screening can be stopped for average risk patients after age 65, many women lack the appropriate amount of screening history to accurately assess their risk.
Navkiran Shokar, M.A., M.P.H, M.D., has received nearly $1.5 million from the Cancer Prevention and Research Institute of Texas (CPRIT) to reduce the burden of cervical cancer in West Texas.
Fewer than three out of five women with cervical cancer received guideline-based care, a new study finds.
A new analysis reveals that for most women, the risk of dying from cervical cancer is higher than previously thought.
Women may only need cervical cancer screening every 5-10 years -- instead of every three years, as currently recommended -- and may be able to start the screenings later in life, according to Harvard T.H.
A new study from the University of Illinois confirms a link between Pap smear screenings and a lower risk of developing cervical cancer in women over age 65.
Lupus confirmed as risk factor for cervical cancer
Cervical cancer is an 'enormous burden' for Latin-American society, and the third leading cause of cancer deaths among women in the region, say Dr.
Related Cervical Cancer Reading:
by Jaime G. de la Garza-Salazar (Editor), Flavia Morales-Vásquez (Editor), Abelardo Meneses-Garcia (Editor)
This book provides readers with a thorough review on cervical cancer, treatment guidelines and emerging therapies available for the disease. It reviews the epidemiology clinical features, diagnosis, and medical management of cervical cancer.
Given the increasing need for preventive strategies, treatment optimization with collaborative and integrative work, this book improves the actual and integral knowledge in this neoplasm. Given the high prevalence of this disease in Latin America, this is an important text for clinicians in this region.
This book outlines the state of... View Details
Johns Hopkins Patients' Guide to Cervical Cancer
by Colleen C. McCormick (Author), Robert L. Giuntoli II (Author)
Johns Hopkins Patients' Guide to Cervical Cancer is a concise, easy-to-follow "how to" guide that puts you on a path to wellness by explaining cervical cancer treatment from start to finish. It guides you through the overwhelming maze of treatment decisions, simplifies the complicated schedule that lies ahead, and performs the task of putting together your plan of care in layman's terms. Empower yourself with accurate, understandable information that will give you the ability to confidently participate in the decision making about your care and treatment. View Details
Choose This not That for Cervical Cancer
by Personal Remedies (Author)
Choose This not That for Cervical Cancer. This colorful book provides comprehensive and actionable nutrition guidelines for how to reduce your risk, prevent and combat Cervical Cancer (CC). If you rather tackle health issues and risks through proper nutrition and lifestyle changes as opposed to prescription drugs and other typical medical treatments, then this book is for you.
Here are the highlights and what makes this publication unique and different from your other options:
A look-up table for over 800 different types of food and their suitability for CC Health... View Details
My Cancerous Hoo-Hah: A Story of Cervical Cancer
Do you know what it’s like to go step-by-step through cervical cancer treatment? The only way to get through it is with laughter, good friends, and an occasional glass of wine. The blog, diary and social media posts in this collection detail every horrible, humiliating and humorous aspect of seeking medical treatment for a woman’s issue in an industry filled mainly by men. The Internet contains many forums for those seeking answers to medical questions, but most of these quickly degenerate into questions from the lovelorn or cries for help from anyone with an unknown itch. What you want... View Details
Cervical Cancer: From Etiology to Prevention (Cancer Prevention-Cancer Causes)
by Thomas E. Rohan (Editor), Keerti V. Shah (Editor)
The last few years have seen enormous progress in terms of our understanding of the etiology and pathogenesis of cervical cancer (particularly with respect to the role of human papillomaviruses), and this has opened up new avenues for prevention. Additionally, there have been further refinements of existing technologies for cervical cancer control. To read about the state of the art on cervical cancer, health professionals have to locate individual articles and reviews of specific topics. In recognition of this, we propose to produce a book that will bring together in one place reviews of the... View Details
Not Quite a Cancer Vaccine: Selling HPV and Cervical Cancer
by Samantha D. Gottlieb (Author)
In Not Quite a Cancer Vaccine, medical anthropologist S.D. Gottlieb explores how the vaccine Gardasil—developed against the most common sexually-transmitted infection, human papillomavirus (HPV)—was marketed primarily as a cervical cancer vaccine. Gardasil quickly became implicated in two pre-existing debates—about adolescent sexuality and pediatric vaccinations more generally.
Prior to its market debut, Gardasil seemed to offer female empowerment, touting protection against HPV and its potential for cervical cancer. Gottlieb questions the marketing pitch’s vaunted... View Details
Cervical Cancer (Diseases and Disorders)
by Kris Hirschmann (Author)
Discusses cancer of the cervix, including the role of human papillomaviruses in causing the illness, treatments, and the controversy over vaccinating preteen girls against a sexually-transmitted disease to lower the chance of getting cancer. View Details
Cell War Notebooks: My Journey with Cervical Cancer
by Julie Forward DeMay (Author)
Beautifully written, heartwarming, and passionate, Cell War Notebooks draws us into a world many are familiar with. Recorded as a blog during a period of seven months, Cell War Notebooks is both a sensitive and brutally honest account of life with cancer. An essential read for people coping with the disease, and for the family and friends who support and love them, it's the deeply motivating story of a battle Julie Forward DeMay is determined to win. One of few memoirs written about cervical cancer, her inspirational journey was published for many reasons, one of which was to create a general... View Details
100 Questions & Answers About Cervical Cancer
by Don S. Dizon (Author), Michael L. Krychman (Author), Paul DiSilvestro (Author)
The only text to provide both the patient?fs and doctor?fs views, 100 Questions & Answers About Cervical Cancer aims to provide a much needed primer for patients and their families and aims to address the questions most relevant to a woman following a diagnosis of pre-invasive changes or invasive cervical cancer. This text gives up-to-date, authoritative, practical answers to your questions about cervical cancer; not only the diagnosis and treatment of the disease, but also female survivorship. This is an invaluable resource for anyone coping with the physical and emotional turmoil of this... View Details
EARLY DETECTION OF CERVICAL CANCER: PAP SMEAR or COLPOSCOPY: ?Correlation of Cytological, Colposocpical and Histopathological findings in patients with Cervical lesions"
by MINAKSHI SARDHA (Author), ARSHAD ANJUM (Author)
Cancer cervix is the 2nd most common cancer in women accounting for 68.5% of all gynecological malignancies.The estimated new cancer cervix cases per year are 500,000 of which 79% occur in the developing countries.Cervical dysplasia does not cause many symptoms;therefore, regular screening and early diagnosis are important. The single most important step that a woman can take to prevent cervical cancer is a pap smear, which is a gentle scraping at the cervix during a gynecological examination.To judge the merits of a pap smear,Colposcopy provides a technique for visualization of cervix and... View Details