The New HPV Test You Should Ask Your Doctor About
By Shari Sims
There's a new, more sensitive way to screen for cervical cancer — yet only 15 percent of doctors are using it. Why the Pap may no longer be enough.
Suppose there were a screening test for cervical cancer that could detect potential dangers with far more sensitivity than the Pap. A test so reliable that when it was done with the Pap, you could trust the results nearly 100 percent. Sounds like all women would be getting it, right? Well...there is such a screen — the HPV test. It's been approved by the FDA and endorsed by the American College of Obstetricians and Gynecologists (ACOG) and the American Cancer Society as an option to be done with your Pap, and yet only an estimated 15 percent of doctors are using it. If your ob-gyn has never mentioned it, read on. Understanding the limits of the Pap and what the new test can do, and getting updated info on who's at risk of cervical cancer, will help you start the conversation.
What is the new HPV test?
Almost all cervical cancers are caused by prior infection with human papillomavirus, or HPV. There are more than 100 strains of HPV, about 40 of which can be spread by having sex. Some cause warts, others no symptoms at all. But some types cause cell abnormalities in the lining of the cervix that, years later, can become malignant. Two of these strains — numbers 16 and 18 — are thought to be responsible for roughly 70 percent of cervical cancer cases. The HPV test literally homes in on genetic coding that occurs in these two, plus about a dozen other high-risk strains. A negative HPV test means that no active virus could be found; a positive result, that one or more of those strains is present.
How is this different from the Pap?
The Pap is designed for visual identification (by either lab technician or computer) of any cells that look abnormal. The HPV test was originally approved by the FDA as a follow-up for women whose Pap results were ambiguous (technically called ASCUS — "atypical squamous cells of undetermined significance"), a category that may affect some three million women every year. Now it's been OK'd as a screening test for women 30 and over, to be done with the Pap and, generally, the same sample of cervical cells.
How effective is it?
Last April, two scientists from the National Cancer Institute, writing in the prestigious New England Journal of Medicine about a study of 131,746 women in India, said that "among...women between the ages of 30 and 59 years...a single HPV test performed 15 to 20 years after the median age of first sexual intercourse will detect many easily treatable, persistent infections and precancers while limiting overtreatment." One test, they wrote, "dramatically reduced the incidence of advanced cervical cancer and cervical cancer mortality."