In the last 10 years it has become apparent that detecting the HPV virus that causes cervical and genital tract cancer is more accurate than the smear test. The Cobas HPV Test was approved by the FDA in the USA for primary screening in April 2014 and similar products will soon replace the smear test which is nearly 70 years old.The smear test has done a marvellous job in reducing the rate of cervix cancer in places where it has been used efficiently,
such as in Scandinavia and the UK. However with molecular technology we now have products which are extremely accurate in detecting the pre-cancerous stages of cervix cancer and which can then effectively allow these stages to be simply treated and cured. Indeed in many studies the detection of cervical pre-cancer has beenincreased by up to 40% by the use of the HPV test.
Another benefit of #HPV testing is that a new form of self-collection has been developed and an exciting symposium at the recent EUROGIN 2015 meeting in Seville discussed self-sampling with the European investigators describing their latest findings using either lavage, urine or swab collection methods. Our own publication on the use of a dry vaginal tampon has also just been published (BJOG 2015;122:388-394).
The studies speak for themselves. Verdoodt and Arbyn showed that women who were never screened or under-screened were more than twice as likely to undergo screening when offered a self-sampling kit compared to an invitation for conventional screening.
The PROHTECT group found that HPV self-sampling reaches the women at highest risk of cervical cancer and that it may be used, not only to complement current screening programmes by increasing screening coverage but may also be offered as alternative to all women invited for cervical screening.
It’s important to realise the role of self-sampling in taking away some of the anxiety associated with procedures such as screening. It can be done in the privacy of the woman’s home or out patients department and can then be given for analysis.
ROLE OF COLPOSCOPY AND HPV INFECTIONS:
Even though the HPV test is positive, only 1 in 6 of the positive women will have the pre-malignant lesion existing at that time on the cervix. The other 5 will still have HPV present and the longer it is present the higher the risk of eventually developing pre-cancer.
To detect the 1 in 6 with existing disease the use of colposcopy is employed, where the cervix is examined through a microscope and the lesion (pre-cancerous tissue) can be easily detected and sampled. Those who still have a positive HPV test will be followed up at regular intervals depending on the type of the HPV virus that is present in the cervix.The type 16 and 18 will require more stringent follow up than the other so called oncogenic HPV types.
It is important to recognise that HPV will exist for only about 12-18 months in 95% of women who are infected with this virus. The majority wouldn’t experience any symptoms. The virus is extremely common in sexually active young women with about 80% experiencing infection during their lifetime. In those under 30 years of age approximately 20-25% will have this virus at any time. However, as the woman ages, the frequency drops to about 3-4%.
The recurring problem of how to manage the woman with HPV positivity but with a negative smear was also enthusiastically discussed at EUROGIN 2015 and the role of molecular triaging to help with this problem was developed.
Hopefully with the vaccine and with improved methods of #HPV detection the rate of cervical cancer will be diminished further.
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