The role of human papillomavirus testing in cervical cancer screening

CONCLUSION

Cervical cancer was diagnosed in 493,243 women worldwide in 2002, and deaths totaled 273,505.20 In the United States alone in 2006, cervical cancer was diagnosed in 9,710 women and nearly 3,700 women died from the disease.21 Cervical cancer is caused by HPV infection transmitted via sexual contact. The incidence of HPV infection can be limited by safe-sex practices or abstinence. The most effective way to prevent cervical cancer is to diagnose HPV infection in its early stages. Cervical cancer screening has achieved remarkable successes in recent years; however, like many other screening tests, it has limitations. A major limitation is that most women who acquire HPV have only a transient viral infection. Therefore, adhering to proven cervical cancer screening protocols is important in order to avoid unnecessary medical workups and invasive procedures.

A major advance in cervical cancer screening is HPV testing, which makes identification of HPV infections readily available within the clinical setting. Despite the expectation of incorporating this test into several cervical cancer screening algorithms, data from clinical trials demonstrate only two specific instances in which HPV testing is beneficial: Reflex HPV testing in women with ASC-US and as an adjunct to cytology in women older than 30 years. These two indications allow triaging of only women at high risk of developing cervical cancer to colposcopy. HPV testing of any another population of women during cervical cancer screening is not indicated because of the high incidence of transient HPV infection in women not likely to have an underlying high-grade CIN lesion.

Finally, even with the quadrivalent HPV vaccine (Gardasil) now in use, PAs are cautioned to continue proper patient education on cervical cancer screening. Counseling should focus on regular screening practices. This is the primary preventive method for all types of premalignant cervical lesions, and failure to be screened is the number one reason for developing cervical cancer in the United States.¹⁶ Women who develop premalignant lesions while participating in regular cervical cancer screening programs reap the benefits of early diagnosis and treatment, thereby avoiding the potential progression to cervical cancer. JAAPA

Lauren Morasse is a recent graduate of the PA program at Wagner College, Staten Island, New York, and practices in cardiothoracic surgery at New York Methodist Hospital in Brooklyn. Adi Davidov is Director, Colposcopy Clinics, and Director of Gynecology, Staten Island University Hospital, Staten Island, New York. Mario Castellanos is Director, Medical Women's Health Division, and Clinical Director of Research, Department of Medicine, at the same facility. They have indicated no relationships to disclose relating to the content of this article.

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