HPV Testing: Is Less, More?
(Ivanhoe Newswire) – An abnormal pap smear can be scary for women. It could be nothing, or it could be an indicator that the patient has Human Papillomavirus or cervical cancer. Typically, an abnormal pap smear means that cells on the surface of the cervix have changed in some way, this is called dysplasia.
One type of dysplasia is called cervical intraepithelial neoplasia, which is usually caused by HPV, and can develop into cervical cancer if left untreated.
Two studies suggest that the recommended post-treatment guidelines for patients with CIN be changed to include HPV testing and fewer cytology tests, which involve collecting cervical cells during a pap smear and screening them in a lab.
Currently the United Kingdom, recommends that patients undergo annual cytology for at least 10 years after treatment for CIN; If it was low-grade CIN, which is not as serious, then cytology is recommended at six, 12 and 24 months. If all tests are negative, the patient can return to routine screening every 3 to 5 years.
One study, done by researchers at the London School of Hygiene & Tropical Medicine and Council in Australia, suggests that a single HPV test six months after treatment is more cost effective than ongoing cytology. They called it the HPV ‘test for cure.’
The researchers took data from six sites across England that returned women to routine screening after a single negative HPV test result at six months. The majority of the women was under 35 years old, and treated for CIN stages 2, and 3, the most advanced.
The HPV ‘test of cure’ saved more than $15,000 per 1,000 women treated.
“Human papillomavirus test for cure would be more effective and would be cost saving compared with cytology only follow-up,” the authors wrote in conclusion. They also recommended the full-scale implementation of the HPV test of cure post-treatment.
But does the cost-saving procedure put women at risk?
The authors say no, early use of HPV testing after treatment prevents more cases of CIN stage 3, and is more effective at early detection of women who are at risk of recurrent disease in the future.
However, the long term safety of these strategies is unknown, and a second study by researchers at the Department of Public Health at Erasmus University Medical Center in Rotterdam, Netherlands, showed that women who have been successfully treated for CIN are still four times more likely to get cervical cancer than women whose pap smears have always been normal. This statistic remained the same regardless of the amount of follow-up care.
Additional pap smears or a biopsy of the cervix is needed to determine the correct course of action. If a biopsy is done and abnormal cells are seen, it is a form of dysplasia called cervical intraepithelial neoplasia.
Clinicians from the departments of pathology and epidemiology at the VU Medical Centre in Amsterdam also suggest that cytology and HPV testing at six and 24 months should be sufficient. They agree that post-treatment surveillance should aim at detecting HPV and they suggest there is no evidence to long term intensive monitoring and that “current guidelines [should] be modified”.
Source: British Medical Journal, October 2012