Cervical Cancer HPV - National Cancer Institute Study Confirms that HPV Testing is the Most Effective Way to Manage Borderline Pap Test Results
According to a major study conducted recently by the National Cancer Institute (NCI), an HPV (Human Papillomavirus) test is the most effective way to manage the over 2 million women every year who are diagnosed with mild abnormalities following their routine Pap smear. The findings are based on the largest cervical cancer screening management trial to date in the United States and were published in the Journal of the National Cancer Institute (2/01).
Recent studies have determined that detection of HPV, shown to be the primary causal factor in the development of cervical cancer, is a more accurate way to detect cancer and pre-cancer than the traditional management strategy of repeating the Pap smear or referring women to colposcopy. In this study, the sensitivity of HPV testing for the detection of high-grade cervical disease and cervical cancer was 96% compared with only 85% sensitivity for a repeat Pap smear.
The medical dilemma of how to manage a patient diagnosed with ASC-US (atypical squamous cells of undetermined significance) has long been a major source of anxiety for both patients and doctors. Most of these mild abnormalities go away without treatment. However, physicians and patients have had no way to determine which abnormalities will go away and which represent more serious conditions - pre-cancer or cancer - that need to be treated immediately.
The six-year study, known as ALTS (ASC-US/LSIL Triage Study), was conducted in four clinical centers involving approximately 3,500 women who had recently been diagnosed with an ASC-US Pap test result.
In the United States, there are an estimated 12,900 cases of cervical cancer resulting in almost 4,400 unnecessary deaths each year. Worldwide, cervical cancer affects 400,000 women annually and, after breast cancer, is the second most common malignancy found in women.
HPV is one of the most common sexually transmitted infections in the United States. While there are approximately 100 types of HPV, only 13 key types are associated with cervical cancer. An HPV test can determine which women have the key cancer-causing types of HPV. It is FDA-approved for use as a follow-up to an abnormal Pap smear for cervical cancer screening and detection.
As the largest cervical cancer screening management trial in the U.S. to date, the NCI study is expected by many to help establish a new framework for patient management following cervical cancer screening.
Info Source: The HPV Test
Cervical Cancer & HPV - Current Research
The ASCUS/LSIL Triage Study (ALTS), a major study organized and funded by the National Cancer Institute (NCI), is currently evaluating different management approaches for women with mildly abnormal Pap test results. (ASCUS and LSIL are acronyms for the two mild abnormalities detected by Pap tests. ASCUS stands for atypical squamous cells of undetermined significance and LSIL for low-grade squamous intraepithelial lesions.) Preliminary findings from the ALTS study suggest that testing cervical samples for HPV is an excellent option to help direct followup for women with an ASCUS Pap test result. Repeat Pap tests or direct referral to colposcopy remain options for the followup of ASCUS results. The final study results, which are expected to be published in about 3 years, will help women and their doctors decide what course of action to take when mild abnormalities show up on Pap tests.
Researchers at NCI and elsewhere are studying how HPVs cause precancerous changes in normal cells and how these changes can be prevented. They are using HPVs grown in the laboratory to find ways to prevent the infection and its associated disease and to create vaccines against the viruses. Vaccines for certain papillomaviruses, such as HPV-16 and HPV-18, are being studied in clinical trials (research studies with people) for cervical cancer; similar trials for other types of cancer are planned.
Laboratory research has indicated that HPVs produce proteins known as E5, E6, and E7. These proteins interfere with the cell functions that normally prevent excessive growth. For example, HPV E6 interferes with the human protein p53. p53 is present in all people and acts to keep tumors from growing. This research is being used to develop ways to interrupt the process by which HPV infection can lead to growth of abnormal cells and, eventually, cancer.
Info Source: Cancer Information Service
