Você está na página 1de 25

HPV testing ,vaccination and gynecological screening

Jamie L.Covell, and Mark H. Stoler, MD

American journal of clinical pathology 2007

Editorial

Introduction
Guidelines Effects of HPV vaccine Role of cervical cancer screening Vs HPV vaccine. Factors influencing the recommendation of HPV vaccine. Challenges for the practicing gynecologic cytopathologists.

Implementation of cervical cancer screening -1950s Reduction in more than 70%. Annual/biennial PAP test. More the advances in the knowledge of the cervical neoplasia more the advancement and accuracy in testing modalities. Vaccines in addition. Primary effect reduction in the annual PAP tests.

In 2002 and 2003, American Cancer Society American College of Obstetrics and Gynecologists, US Preventive Services Task Force published revised guidelines for cervical cancer screening related to onset cessation frequency of PAP test screening.

Screening should begin 3yrs after the onset of sexual activity or by the age of 21yrs,which ever occurs first. Cessation of screening can occur at the age of 65 or 70yrs with documentation of 3 negative PAP test results with in the preceding 10yrs. Screening should occur every 2-3yrs,for women 30yrs and older who have dual screening with PAP test and HPV testing, with a screening interval of 3yrs,if the results of both the test are negative. Screening is not recommended for the women after hysterectomy, except in patients who had cervical neoplasia.

Simple adherence to these guidelines will decline the volume of the PAP tests. Solomon et al, used the data from multiple national health surveys and US senses bureau to estimate PAP test volumes. Concluded adherence to these guidelines with biennial(18-29yrs) and triennial PAP test screening and high risk HPV testing (>30yrs) reduction in PAP test volume by half, by 2010.

ASCUS-LSIL triage study (2003) provided the evidence clinical usefulness of the HPV testing to triage PAP tests. 85% ASCUS cases were triaged. Excellent negative predictive value of combined testing in ASCUS-HPV negative cases eliminates the need for short interval repeated PAP tests - further reduces PAP test volumes. (University of Virginia Health System)

Changing trends???? Difficult but is absolutely essential for the appropriate utilization of these new technologies. Inappropriate use of HPV testing adds significantly to the cost of already overburdened womens health care.

HPV vaccines
Current vaccines completely protect against most common oncogenic HPV types(16,18) in unexposed adolescents and women. Second generation vaccines provide 90% protection under process.

Full effects of cancer prevention with HPV vaccine and reduction in the screening tests may take a very long time. But there will be some impact on the frequency of the abnormal tests Significant fraction of almost all the abnormal Bethesda reporting categories are due to HPV (6,11,16,18)

Impact on vaccines
Social and cultural pressures Vs political and manufacturer pressure. Vaccines are not completely effective in women with established infections. Current vaccines not useful against HPV types responsible for 30% of cancers. Duration of protection is not known.

Until these issues are solved, women will still need to be screened regardless of vaccination status. HPV testing is more sensitive and of more predictive outcome. Reducing the volume of PAP testshow large and how soon???

Challenges to be faced
As the volume of PAP test decreases application of PAP testing changes Cytology practitioners focus on nongynec and FNAC cytology and expansion of molecular pathology. Requires higher skill levels and additional training. As a cytopathologist one can choose to fight or flee.

Summary
Adherence to recommended screening guidelines will decrease the number of PAP tests annually. Expansion of HPV testing and HPV vaccines will further reduce PAP test volumes in coming decades.

GARDASIL - cervical cancer vaccine that helps protect against 4 types of human papillomavirus (HPV): 2 types that cause 70% of cervical cancer cases, and 2 more types that cause 90% of genital warts cases. It is for girls and young women ages 9 to 26 and is given as 3 injections over 6 months

CERVARIX also given gives protection to 2 types of HPV.

Thank you

Você também pode gostar