B (5:26)

Foreign.

B (5:49)

This is Dr. Chapa's obgyn no spin podcast.

B (6:19)

Yep. We've covered patient self collection of samples for STI and for primary HPV screening on this show in the past. I know we've got several episodes on that. You can go back to the archive and look at that. But I just want to get to this new guidance from ACS because it's making the medical news cycle and it should because this really is the first time that it's released something like this that it allows regardless of site of collection. Right. So this isn't just for home or clinic use. It's either one. And these New guidelines released 24 hours ago make two things clear. Number one, with patient instructions, self collection of a vaginal specimen for HPV testing is legit. The data shows a very small error rate, again with instruction. And so that's totally okay for those patients who just don't want a provider to do it. Now, if there's a complaint I'm having weird discharge, you know, a weird odor or something else that probably needs a clinician's eyeballs. But for otherwise screening. Meaning they're asymptomatic. Yeah, this is great. It definitely has a role. So that's the first thing. It's okay for vaginal specimen collection by the patient for cervical cancer screening using hpv. The second thing is that push again that primary HPV screening and is really the way to go. Okay, so if you're doing cytology, no problem. And then where you do the cytology first and then reflex to an hpv in cases of like asc, US or co testing, that's okay. But look how far we have come because now the appearance of the cell, you know, it's atypical. Is it dysplastic looking or not? That's basically gone if you follow the HPV algorithm, especially with one specific company that uses dual stain technology. Okay, we've covered this before. So. So if you are high risk HPV 16 or 18 positive, you go right to COPO. But if you're other high risk positive, then dual stain technology looking for the specific protein markers. Now we're looking at a molecular level. If those two stains are positive in a cell, remember it's actual staining, It's a dual stain. Then they go to colposcopy as well. And if they are dual stain negative, they don't need colpo and they can just repeat the HPV assay in a year. Okay. And the dual stain, remember, is looking for two protein biomarkers in these cells. It's looking for P16, which is the tumor suppressor protein, and then Ki or Ki67, which is a marker of cell proliferation. So first you knock out the tumor suppressor, so P16, and then you get cell proliferation or replication manifested by ki or okay, P16, Ki67, both of those. That dual stain, if that's positive, you go straight to colpo. All right, so I love this. I think it's fascinating. Again, cytology is still used because you're looking for those stains at a molecular level within the cell, but you're not looking at the actual appearance of the cell. You're just looking for the presence of the stain. We have covered that in the past. Okay, so very quickly, knowing that HPV, primary HPV screening started at age 25 really does have a lot of advantages here. I just want to read you some quick synopsis, a couple of sentences here that drive the message home of this new guidance change. All right, so the first thing is, is that if a clinician does this with a regular old speculum, because now this tends to be more cervical collection, you can increase the testing frequency or keep it rather at five. Okay, so when clinician collected, when a cervical sample is used for primary HPV testing, the repeat screen is still every five. That's after a negative test. We get that now here's the catch, guys. Here's one clinical pearl right now for self collected vaginal specimens, ACS says, hey, I think that's great. Phenomenal. Congrats. It's high risk, negative. But if you're gonna collect it yourself, then you need to repeat the test in three years after the negative result. So self collection of HPV gets a retest not in five, but in three years. Now remember that this is acceptable self collection according to the acs, American Cancer Society is allowed or acceptable for those at average risk and for women that are at 25 to 65 years. So the typical screening, okay, this doesn't have to be over 30 or you know, doesn't start at 21, is between 25 to 65. For those women at average risk, they can self swab and if it's negative, they repeat in three years. Amazing. So there's a lot of things issues here that are super important. Now that's at average risk. If a patient, for whatever reason, based on her history or past exposure or whatever, is high risk, clinician collected samples are still recommended. So I'm going to be very clear. Please don't go. Hey, I know you've had dysplasia for the last six years. No problem. Here's your self swab. Stick it up there. Roto Rooter, the Vajuju. Put it into the little container. Perfect sample. Nope, that's not what we're talking about here. That is for patients at average risk. But for high risk women, clinician collected samples are still recommended. But if there's some caveat where she's like, it's not happening. You're not going to look down there. I'm going to do it myself then that's fine. You just remember that's part of informed refusal. You simply document that it's out of protocol and they can do whatever they want to do. Okay, so once again, this is a big deal. Starting at age 25 to 65, that vaginal collection. Vaginal specimens are, quote, acceptable for average risk patients with repeat testing in three years after a negative result on self collected HPV screening tests. End quote. But for high risk or those at higher risk of dysplasia, maybe those with a past history, quote clinician collected samples are still recommended, end quote. Fascinating, fascinating, fascinating. So this is basically an update to the 2020 ACS guidelines, which of course are now recommending HPV testing in the general population. HPV seems to be the way to go, so found this super interesting. Again, this is in the journal Cancer and if you're not sure what that's about, it's a cancer journal for clinicians. Sarcasm added. And the title is Self Collected Vaginal Specimens for Human Papillomavirus Testing and Guidance on Cervical On Screening Exit. An update to the American Cancer Society Cervical Cancer Screening Guideline. Man, that's a lot of words. Very quickly we talked about the self collection. The title also says Guidance on Screening Exit. So let's talk about that next.

C (13:42)

Me and Vincent would have been satisfied with some freeze dried taste.

B (13:46)

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D (14:25)

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B (14:53)

All right podcast family, let's wrap this up real quick about when to exit screening. Now we all get that it's age 65. We all remember that number. But what was interesting was the interval of exam. So in other words, let's say on a CO test a patient had it at age 60. All right, y' all get this at age 60. Well then the next one would be at 65. Ah, but lo and behold you are 65 and that's when we exit screening. So then you're like, ah, you're good as long as your last one within the last five years was negative. You basically timed yourself out at that point. Okay, well, here's a little change. Okay, again, not asccp, but acs, which I think is very valid. And their point is, hey, man, some women do develop cervical cancer after the age of 65, and so you got to cover that spread a little bit better. So let me read this exactly from this article again 24 hours ago. Released 24 hours ago. And they're going to wrap it up. Quote, the ACS has amended previous guideline to recommend HPV testing at ages 60 and 65. With the last HPV test, here it is, guys at an age no younger than 65 as a requisite to exit screening. In other words, telling a patient, oh, honey, don't worry about it, grandma. You had your last one at 60. It's good for five years. And now you're 65. That's when we stop screening. So you're good, you don't need it. No, no, no, it's including. In other words, 65 is not excluded of. It's included in that revised GU. So they need one at age 65. Let me read you the revised recommendation quote. To qualify for discontinuation of screening, the ACS recommends an average risk woman or an individual with a cervix. Okay. Oh, gosh, there we are again. Individual with a cervix, that's a woman at average risk, have regular primary HPV tests, which is preferred, or a negative CO test, which is HPV and cytology at ages 60 and 65. If primary HPV test or a CO test are not available, three consecutive negative cytology Pap smears are at the recommended testing, are recommended prior to screening exit. So, short answer, that's a lot of words to go. 65 is not. When they don't need it anymore, they need it at 65 and then they can stop. So that's to. To increase the watershed area and preventing us from saying, well, you've had one five years ago, you're good, you don't need one anymore. So, no, it is not over until 65, at which time you now have your last test. And they recommend, of course, using the screen as primarily HPV as a modality. All right, so it's not a huge change there. Just a clarification that it's not excluding that 65, it's including 65 as the last age when to test or screen. Okay, again, in the average risk population. So, podcast family, I think we've done what we're supposed to do. This is supposed to be very targeted. Just reviewing what came out on Dec. 4, 2025, in cancer. Once Again, a cancer journal for clinicians. Now that we've done all that, Michael, let's end this. This was pretty quick. Let's take it home.

B (18:41)

This has been Dr. Chapa Zobichyn no Spin Podcast.

B (18:48)

Podcast Family, thank you for your support. Thank you for listening. And as always, we'll see you on another episode of the no Spin Podcast.