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Healthier World with Quest Diagnostics
34 - Instant insights: HPV testing for cervical cancer screening (8 min)
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Foreign welcome to Healthier World with Quest Diagnostics. Our goal is to prompt action from Insight as we keep you up to date on current clinical and diagnostic topics to transform lives and illuminate a path to better health. Welcome to a special episode series called Instant Insights, a podcast episode designed to give you quick and highly impactful clinical pearls in just a few minutes. Dr. I'm Dr. Mason Latsko and today we'll be discussing HPV testing, what it is, why it matters, and how current guidelines are shaping cervical cancer screening today. Cervical cancer is the fourth most common cancer in women globally and more than half of new cervical cancer cases occur in women who haven't been screened in the last five years. Despite the fact that cervical cancer is one of the most preventable cancers, a gap in screening remains a major health challenge. Human papillomavirus, or hpv, is responsible for nearly all cases of cervical cancer and in particular two strains of HPV are responsible for the majority of cervical cancer cases worldwide. These strains are HPV 16 and HPV 18. The good news is that screening works When HPV infection or abnormal cells are detected early, clinicians can intervene early before the cancer develops. Today, clinicians have several evidence based options for cervical cancer screening and these include Pap screening, HPV testing and CO testing which includes both HPV testing and Pap screening. Now, Pap screening is a cervical cytology test that involves looking at the cells from the cervix under a microscope to identify if any abnormal cells are present. HPV testing uses DNA or MRNA based PCR to detect high risk strains of HPV such as HPV 16, HPV 18 and 12 other high risk strains. Importantly, CO testing with Pap and HPV testing together helps identify more cases of cancer and pre cancer than either test alone. In fact, a retrospective longitudinal study at Quest Diagnostics studied women who went on to be diagnosed with cervical cancer in the next 12 months. CO testing reduced false negatives and increased true positive identification of cervical cancer compared to Pap and HPV testing alone. In other words, co testing with HPV and Pap screening improves identification of cervical cancer in women. Guidelines from organizations such as the U.S. preventive Task Force or ACOG and the American Cancer Society support various combinations of these approaches depending on the patient's age and clinical context, and these options allow clinicians to tailor screening strategies based on the patient's risk, their preference and access to care. Let's walk through this. For example, in women ages 21 to 29, a Pap test alone or a Pap test with reflux to HPV testing is recommended every three years. In the case of the reflux test, the HPV test is only going to be performed in the presence of an ASCUS Pap or an atypical Pap. In women ages 30 to 65, the recommendation is a Pap test every three years, primary HPV screening every five years or CO testing every five years. Now CO testing in this population of women ages 30 to 65 involves the processing of HBV and Pap testing at the same time. The clinician also has a choice to add genotyping to this test and this can either be run simultaneously to the screening or as a reflex in the instance that the Pap is normal but the HPV test is positive and this will allow the clinician to identify what strain of HPV is found in that patient. In women ages 30 to 65 who receive a Pap and HPV testing separately, they have a few choices for their HPV testing methodology. The first is called HPV Primary and this is a cervical collection that handles screening and genotyping all in one step. So the clinician will identify whether or not the patient has a positive HPV test and what strain of HPV is present in that patient. In the case where the patient is positive for an HPV strain other than strain 16 or 18, the test will automatically reflex to cytology to identify what of the other 12 high risk strains is present in that patient. Another option for patients ages 30 to 65 for HPV testing is HPV self collection and this is a vaginal swab that can be considered by clinician when it's not possible to collect a cervical specimen such as a patient with discomfort or pain during a traditional pelvic exam. However, the results of this test do not reflex to cytology like the HPV primary test so a follow up appointment may be necessary. Based on these results. This FDA approved self collection method is reshaping cervical cancer screening by increasing accessibility, reducing barriers and empowering women to pursue a private and comfortable screening for cervical cancer. As screening strategies continue to evolve, Quest Diagnostics is supporting clinicians with testing options that align with guidelines and patient needs to summarize that includes the Pap with reflex to HPV testing in women 21 to 29 and several options. For women 30 to 65. This population can receive co testing with the option of adding HPV genotyping in the instance HPV results are positive or HPV primary testing which includes HPV screening and genotyping all in one or HPV self collection, which includes a vaginal swab and is more appropriate in certain populations. Management after a positive HPV test depends on the specific HPV type and the cytology Results. Detection of HPV 16 or 18 can directly lead to a colposcopy given the high risk of cancer associated with these strains. Detection of other high risk HPV types may prompt follow up cytology or repeat testing in one year, depending on the overall risk assessment. For clinicians looking for additional guidance on risk based management after an abnormal cervical cancer screening result, the ASCCP Management Guideline app is a useful digital resource that consolidates current guidelines and helps support next step decision making. Cervical cancer prevention has come a long way. With multiple screening options such as the Pap test, the primary HPV screening and the self collection, we now have the flexibility to make screening realistic for more patients. These options help to empower women to engage in screening that can ultimately help us move closer to eradicating cervical cancer. That's a wrap on this episode of Healthier World with Quest Diagnostics. Please follow us on your favorite podcast app and be sure to check out Quest Diagnostics Clinical Education center for more resources, including educational webinars and research publications. Thank you for joining us today as we work to create a healthier world, one life at a time.