Many of you may have heard in the news that the FDA recently approved a new screening test for cervical cancer. We are CWCC think this is very exciting news, especially for women in the developing world, and we know you will be interested to hear the details.
As you all probably know, cervical cancer is almost always caused by the virus called HPV (human papilloma virus). We discussed this is another blog and here is the link to get you up to date on that information. (http://cwccblog.com/do-i-still-need-a-pap-smear-every-year). The short version is that most of us are exposed to the HPV virus at some point in our lives through sexual activity, but in the majority of cases our immune system clears it up and no treatment is required. That is why it is not recommended to even test for it in women under 30, because it’s so common and usually goes away. If we still carry it when we are over 30 it is less likely that it will clear on its own and we start watching more closely for signs of pre-cancerous change which can be treated easily in most cases before any harm is done. For patients who follow these guidelines, cervical cancer is extremely unlikely to develop.
Traditionally we have done cervical cancer screening by doing a pap smear, which gets a sample of cells from the cervix to examine for precancerous changes. In addition to checking the cells, for patients over 30 an HPV test is added. In reality, for patients over 30 we are really only reacting to the HPV result, so the cellular part is of little or no value, since precancerous changes essentially go along with a positive HPV result, and if the HPV is negative we essentially disregard the cellular test results. Following that evolution in practice over the past few years, a new test has been approved which only tests for HPV, and this could theoretically be done at home with a vaginal swab that patients could do themselves. Essentially it is the exact same test that is currently done from a traditional pap smear in women over 30.
The test checks for the DNA of 14 types of HPV which are possibly players that could cause cervical cancer (there are over 50 types of HPV, but most of them don’t cause cervical cancer). The current suggested guidelines for this product are to ask patients with a positive test to come in to see the doctor if they have a positive test, and if they test positive for one of the most “high risk” types of HPV (either type 16 or 18) then the recommendation is to do a cervical biopsy to check for precancerous changes. That is also pretty much what we do already when handling traditional pap smear results, although we may wait a year in some cases to see if the HPV goes way before we do a biopsy.
Critics of the new test worry that if too many young women do this test that it may lead to over treatment of patients who are HPV positive when the virus normally clears on its own. We agree that women under 30 should NOT do this test, for the same reason that we haven’t recommended that for years with the traditional pap. We also are concerned that if this test is done at home and patients over 30 are negative for HPV, that they won’t come to their annual exams, and it is important to remember that there are many other disease processes that we screen for at an annual exam, including ovarian, uterine, breast, bladder, vaginal and vulvar issues. But overall we think it is a great development, and will be a fantastic tool for women to use in environments where medical care is hard to find, such as in the developing world, where most cervical cancers occur. In places like Africa this test could allow triage large numbers of women without the need for a medical exam, and follow-up of HPV positive patients, particularly those with HPV type 16 and 18, could be directed to a clinic that otherwise would be overwhelmed by screening the entire population.
While this test has been approved by the FDA, at the time of this blog it is not currently available to the public or to doctors. If a patient is in our office having an exam, we will currently continue using the pap smear and HPV testing for women over 30, but we look forward to finding out what the future holds for recommending that certain patients do this test themselves at home as an adjunct to their annual exam and will keep a close eye on this product so that we can keep you up to date.
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