Variation in Genetic Testing Rates Seen for Patients with Breast Cancer

05 July, 2018, 22:06 | Author: Kara Nash
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Nearly each type of cervical cancers is caused due to the infection by one of the 12 types of oncogenic human papilloma viruses (HPV).

In the last five decades, the Pap smear test has been used to screen for early signs of cervical cancer. The women who actually received Pap smear showed twice more chances of having abnormal cells. He said that physicians will have to make the choice between HPV testing and co-testing based on cost-effectiveness studies and their own discretion, while continuing to improve outreach for underserved and inadequately screened women to combat such high rates of cervical cancer.

The study, published in the Journal of the American Medical Association, adds to a growing body of evidence that HPV tests may be superior to Pap smears.

Despite the widespread screening programs, it was estimated that 12,820 women would be diagnosed with cervical cancer and approximately 4,210 would die from cervical cancer in 2017.

Because health care is a provincial responsibility, it's up to the individual provinces and territories to decide whether to adopt HPV testing instead of Pap testing for cervical cancer screening.

Dr. Gina Suzanne Ogilvie of the Women's Hospital and Health Center in Vancouver and colleagues set up a comparison study.

Although there could be increased costs associated with sending more patients for additional tests and monitoring after HPV detection, those may be offset by the fact that people may not need to have the initial screening as often, she said. This finding upends traditional practice norms, which often rely on cytology testing via a Pap smear as a primary screening method for precancerous lesions. They also found that the HPV test was a better predictor of women who would be cancer free in future compared to Pap test.

The Task force states that for women aged between 29 and 65 HPV tests alone every five years can be the only screening test. They recommend further studies to help researchers understand long-term clinical outcomes and cost-effectiveness across both tests.

But in recent years, most medical groups have been recommending women get both tests, and some experts are pointing out that such so-called "co-testing" may be better than the HPV test alone at detecting precancerous changes; the study did find that in a small number of cases, Pap cytology identified precancerous lesions that HPV testing did not. Consistent with prior studies, more cases of abnormal cells in the cervix, known as cervical intraepithelial neoplasia (CIN), grade 3 or worse (CIN3+), were detected in the intervention group compared with the control group in the first round of screening. If the HPV test is negative, it gives more assurance that women will not develop precancer in the next four years. Both group were tested again using both methods after four years.

One caution about the study findings, says Dr. Carol Mangione, a USPSTF task force member and UCLA professor of medicine, is that screening - either kind - is what saves lives. These conditions can be treated before they progress to cervical cancer.

Moving away from co-testing may not be a good idea, according to Mark Spitzer, an OB-GYN and past president of American Society for Colposcopy and Cervical Pathology. But there were still no final guidelines issued on this and that's why the new study might be important in helping with the decision.

The HPV test was more likely to pick up pre-cancerous cervical lesions earlier in the study, so the women in this group were significantly less likely to develop invasive neoplasia, or cervical cancer. He called use of the HPV test only a "reasonable strategy" but noted that the test's strength - its sensitivity - could result in more positive results and more testing.

Whether they receive a Pap test or an HPV test, the experience for patients is the same in their doctor's or nurse practitioners' office. "The real benefit of co-testing is with the HPV test", she said.



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