Thursday, October 18, 2007
New test for HPV
If women have latched on to anything from the onslaught of TV ads for the cervical cancer vaccine, and now for a special genetic test for human papillomavirus versus (HPV) , it's the idea that the chances of getting the disease depends a lot on the individual.

Consider, HPV causes most cervical cancers.

Of all the women in the U.S. with cervical cancer, 60 percent had never been screened, or hadn't been screened in the last 5 years, according to the American Cancer Society. That's why women should be diligent about getting their Pap tests. It's the gold standard for detecting cell changes in the cervix that could be caused by HPV.

But now, there's fresh interest in a different kind of test - a DNA test for HPV, a swab done during a regular pelvic exam, that its supporters say is better than the Pap, and may even muscle it out as the cervical cancer screening method of choice.

So, many women will ask - "Do I need an HPV test?"

The New England Journal of Medicine features a pair of studies extolling its virtues.

One, a Canadian study looking at more than 10,000 women, found the HPV test correctly found 95 percent of the lesions that could develop into cervical cancers; while the Pap test found only 55 percent.

Most women would take those odds, but it's not that simple.

First, the HPV test is only for women 30 years old and older. Think of it like this - virtually everybody who has sex is exposed to HPV, but the vast majority of HPV infections just flush out of a woman's body. So the test is only used on women 30 and older to reduce the number of transient infections.

And what exactly does it mean if you test positive for HPV? The HPV test has shown to be more sensitive than the Pap, but it's also less specific - so it can have a slightly higher false positive rate.

So a positive result could mean you need a follow-up test 6 to 12 months later. If that test is positive the HPV could have been hanging around awhile, putting you at risk for cancer.
Or it could mean nothing at all. There's concern too many people taking the test would test positive for HPV and get unnecessary treatment as a result.

Another issue - and not a small one - is that the HPV test isn't widely available and it is not always covered by insurance.

For now, the American Cancer Society says women should be screened using the Pap test, or Pap plus the HPV test if she chooses, because the HPV test does offer added benefits over the Pap alone. At this time, women can only get an HPV test along with a Pap test; it's not FDA approved as a primary screening test.

A benefit of double screening if both the HPV and a Pap test are negative is that doctors say you won't need another screen for three years, so it may save you a trip to the OB/GYN.

But, will HPV testing supplant Pap tests? Dr. Brian Slomovitz, Assistant Professor in the Division of Gynecologic Oncology in the Department of Obstetrics and Gynecology, New York Presbyterian/Weill Cornell believes we're in the cusp of a "revolution in cervical cancer screening" as we know it.

The American Cancer Society is quick to point out that questions remain.

The most recent research comparing these screening tests appears in the October 18 issue of the New England Journal of Medicine.

Will you seek out the new HPV test in addition to a Pap test on your next doctor's visit? We'd like to hear from you.
I most certainly will speak to my Doctor and request the HPV testing. Taking a pro-active stance in cervical cancer is the smart way to go. We need to take advantage of these medical break throughs to assist in earl diagnoses.
I would absolutely ask for an HPV test. The data has been available showing greater sensitivity than pap alone long before the NEJM article. Paps have been missing cervical cancers in women for years, and I choose not to be one of those women. I think physicians may be afraid of change, as my GYN is not offering the test outright, but performed it when I asked. I think clinicians need to have their patients best interest in mind and begin offering this test to all women over 30.
States should be spending preventive care dollars on the DNA screening test, not the HPV vaccine. Women who get the vaccine still need to be screened. The vaccine is simply preventing infection with two strains that the large majority of women will clear on their own anyway. Whjat a waste of dollars when there is such an effetive screening tool.
I think that this new testing is very relevant. As a health care provider in Canada I will be seeking out whether these services are availible in my Area and as such will be suggesting to my clients to ask about it as well.

I can see this test making an impact. What a relief for a women who has had both the pap smear and dna testing result negative. To not have to return for that exam for three years.

It will be interesting to know exactly how this new method and the others that will surely come after, will change the face of women's health.
I am a bit confused by all the HPV informatio out there. If there is a greater chance of "false positives" with certain tests (which can cause devastation to relationships and other aspects of a young persons life) why would we want this? I am so against young girls getting this immunization as part of their immunizations as I feel this is telling our children to go have sex. And, they are wanting to start it at age 11 or so! No way. My daughter will not get the injection until she and I discuss it at length and she is able to understand that her actions have consequences when it comes to sex. I will encourage abstinence more than anything. I realize that we live in a different day and time now, but when I was 11, sex was the furthest thing from my mind, and they are talking about HPV testing, immunizing against it, and giving birth control at school. I hope these schools have malpractice insurance in the event a child has a rare disease that can cause problems when they take birth control. I think it is up to us, the parents to determine these things for our children, and I know that not every parent will do that, but I am willing for my child, and for any other child that their parent would allow me to instruct. I worked for a doctor for nearly 20 years, so I think I have a little knowledge in the area of sex, so to speak. I do believe that each child should be immunized for basic things such as Measles, Mump, etc, but I do not think it necessary to immunize a 6 year old for meningitis, nor Hepatitis, nor HPV. I just do not think we need to pump their little bodies full of this stuff. After all, how much of this stuff was prevalant when we were kids? Think about it.
HPV is such a new concept that I find most individuals don't know anything about it. I didn't know much beyond the basics myself before I was diagnosed with it. I think if we can get the word out about HPV and how serious it is plus these other measures they can take like Garadasil and the HPV test then at least some will take that initiative because they are scared... and some is better than none because then those few might not pass it along to a few more, etc. I will recommend the HPV test in the future to others now that I know about it and hopefully they will see how lifesaving it could be. I have HPV in the high risk stage for cervical cancer at the age 22 and am currently undergoing treatments to make sure this doesn't develop into full blown cancer so anyone reading this... please know that this is a serious thing and you should protect yourself as much as possible and help others be aware.
I am due to have my annual well woman next week. I don't think I am going to be concerned with HPV too much since I've been married and with the same man since I was 17 and have had normal paps since. I don't have any question about hubby's faithfulness, so I think that would be a good enough reason not to be too concerned, even though I am over 30, correct? Unless of course I have a change in my relationship status someday.

My 19 year old daughter will be starting the vaccine soon even though she is not yet sexually active. I am sure she will be someday. : ) I think it's wonderful this is available now. I am very interested to see how it effects the cervical cancer statistics in the future.

Love your blog, btw. I frequently share your postings with my coworkers. : ) Leads to some pretty interesting conversation.

Take care.
I highly recommend that women get screened for this as it is very important to receive treatment. However, I dont quite understand why it is only available to women who are 30 years or older. I also do believe that this exam should be performed at every womans yearly pap because cells change so rapidly and spread fast. On the other hand, i do not think this should replace the annual pap us women get.
I've been married to the same man for twenty years. I've gone to the same doctor for the past ten hand have never had an abnormal pap smear until this year. Last year, by doctor gave me my thinprep and it was normal but I had HPV. So she redid both this year and my thinprep still says nothing is wrong but I still have HPV. My doctor sent me to another doctor and they used a copposcope and now I have high grade disease. I've gone through laser treatment and am in a holding pattern till I get my next test. If HPV is the cause of cancer, why didn't I get tested with it sooner?
If it were a man, you bet that any screening would be available. Our country invites unwanted preganancies however once children are brought into this world and are adults (by societies standards) they are out of luck. There is no reason not to give any woman both tests! Ask the president or CEO of any insurance company what he would want for his daughter, grandaughter or wife. Further, ask any politican! This country's medical system needs to be revamped. Hey, if you have tons of money, you can get anything you want. Whaqt about the middle class and below? Think about it!
It is a must. My mother passed away from cervical cancer 30 years ago. Had the HPV test been available then she would likely still be alive today. Think of all the women who lost mothers at an early age so many years ago and thought they caught cancer from cleaning products, etc.? Our insurance carriers also need to step up women's preventative care as well.
I just sent this news to my friends at pozgroup.com. Many of them want to know that if they are tested by pap as hpv positive, is it possible they are negative with the new HPV test? Will the new test change the reality that they are HPV positive?
I am 23-years-old and not sexually active. At my next exam (most likely in April), I will just get the pap and not ask for the HPV test. I am hoping that my new gynecologist won't push me to have it.
There are a few things TV and drug companies do not want to tell you. First, HPV is an STD. Do not worry about it if you are not sexually active.

Second, not all HPV can be detected using the HPV test. If it becomes the screening norm and the pap is eliminated what happens to those women who get another type of HPV not tested for using the HPV test?

Third, what happens if you test positive for HPV but nothing shows up on your pap? Are there going to be swarms of women going in for unnecessary biopsies because of a positive HPV test that in most women would never lead to any abnormality? If 50% of sexually active women have HPV what good is a positive HPV test? Odds are if you have sex you may have HPV.

And finally, the clinical trials that you read about...who do you think has paid for them? At the end of the day do you think the HPV testing companies care more about you or about their bottom line?

Don't get me wrong I think HPV testing used together with a pap showing atypical results is great. But, in my opinion for the HPV test to become the gold standard would be a mistake and would lead to many , many unnecessary tests and biopsies. Also, think about the emotional stress put on someone who has to go through all of that.
I have just had an extensive LEEP procedure after discovering that I had severe lesions from HPV, something that did not show in a pap smear the year before. Yes, I had cancer. Where I got the HPV is anyone's guess; my doctor told me I probably had had the virus for years, but due to recent stresses such as the death of my father and discovering that I also had kidney disease, could have caused the virus to erupt into the HPV strain that causes cancer. I say, get the test. If you are younger and sexually active, get the vaccine. Anything we can do to help protect ourselves is the positive thing to do.
In regards to the previous comment about the increased amounts of false positives with the new DNA test: The specificity of the new DNA test, which is a measure of the amount of false postitives, was 94.1%, meaning that about 6 out of 100 people screened would get a false positive result. For the pap test, about 3 out of 100 people would get a false positive result (spec=98.7% NEJM 10/18/2007). While this means the new test would have a few more people getting false postitives, we also have to look at the substantially lower amount of FALSE NEGATIVES with the new test, as measured by sensitivity. The new DNA test yielded a sensitivity of 94.6%, meaning that about 5 out of 100 people would receive a false negative result, indicating that they were NOT at increased risk for cervical cancer when THEY ACTUALLY WERE. Contrast that with a 55.4% sensitivity for the conventional Pap test, meaning that 45/100 people received false negative results. 45 people that were at increased risk for cancer that the Pap test missed! Thats a lot! When comparing two screening exams, its generally better to go with the one that yields less false negatives, even if it means more false positives. With a false positive result you can always get retested, but with a false negative you go home thinking you are ok, when you may actually be harboring potentially cancerous cells!
As a cytotechnologist (a laboratory professional who screens pap smears), I grow tired of all the false accusations toward the pap test. It is the pap test alone that has reduced cervical cancer deaths by 74% since the 1950's, the leading cause of cancer deaths among women back then. Please keep in mind that all the news articles you read or hear about HPV testing and vaccine are based on research funded by the companies that want to sell their product. The stats don't tell the whole truth. In fact, the recent article stating the pap test's sensitivity at 55% refers to the conventional pap test. The liquid based pap test is superior to the conventional smear and has a sensitivity equivalent to that of the HPV test and is more cost effective (do you know the cost of a HPV test?).
My final thoughts, continue to get your annual pap test. The HPV test only confirms infection, the pap test tells you if you have disease and thats what your clinician wants to know.
My issue with all of this, is that if HPV is the cause of cervical cancer, why was the HPV component of the Pap Plus not ran each time? I have been diagnosed with HPV, yet no one can tell me how long it has been in my system because this is the first year we asked to have it ran. On all the lab reports from prior years, it says that the HPV component was not ran because the pap component was normal. Instead, they say that my husband or I have magically contracted this disease decades ago, even though we were both virgins when we married. So is the test really accurate? If it is, then which doctor gave it to me with the speculum?
I was diagnosed with HPV this past week. I am very confused as to what happens now. I am married (have been for 12 years) and this is just now showing up? I do not question my husband's faithfulness, but with this, what am I supposed to think? Since I have to have the LEEP procedure, does this mean I will be reinfected once we have sex again? Can anyone explain?
In my 14 years of experience in dealing with pap smears, I have to say it is still way too early to be trusting the HPV test and vaccine as a one stop shop or answer. If you have a positive test, there is a 50/50 chance that it is actually negative. The same holds true if it is a negative test. The pap is still the best tool out there. The big drug companies are using their money and influence to replace the most cost effective and successful screening test ever. Don't let them!!
Get your PAP and also ask for an HPV test.
I have HPV and I have had only one lifetime sex partner my whole life, my husband of 17 years. We've been a couple for 24 years and we were both virgins and I thought we each had only been with the other for year. Four months ago when I was diagnosed, I asked my husband if he had been with another woman during the 24 years of our relationship. He finally confessed he had cheated on me during our first year of dating. It has been a tough dose of reality to swallow.
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