The FDA Approved the New Guidance HPV Testing For Cervical Cancer but Many Doctors are Not Convinced


Women are advised to undergo two screenings for cervical cancers. The recommendations made by two medical organizations is for women to first  undergo the human papillomavirus (HPV) screening before the Pap smear or Papanicolau screening.

However, all major medical organizations do not accept or  believe the new guidance. The document containing the instructions is available nonetheless for doctors who are interested in performing the HPV screening according to the lead author Dr. Warner Huh, from the Society of Gynecological Oncology and the American Society for Colposcopy and Cervical Pathology

The U.S. Food and Drug Administration has given its go signal for the use of the HPV screening. Huh said that there’s more important aspect in the testing than just obtaining the FDA approval and it “is getting accurate information to providers so they can understand the approach,”

According to the Centers for Disease Control and Prevention that in 2010, approximately 12,ooo American women suffered from cervical cancer and around 4,000 died from it.

HPV is believed responsible of more or less 91 percent of cervical cancers.

Currently, testing for both HPV test and the Pap test is done involving the same procedure. Cells from the vagina and cervix are scraped and sent for lab testing. Pap test is done solely to confirm the presence of pre-cancerous cells while the HPV test, is performed mainly to look for the existence of the virus.

According to a report, a research study last summer revealed that HPV test is more accurate at diagnosing the presence of cervix cancer in women compared to the Pap test.

The probability of women developing cervical cancer three years after testing negative using the HVP test, according to the study, is much less than a negative Pap test.

Upon reaching the age of 25, women should undergo the HPV test. If the result proves negative there’s no need to perform another test for the next three years. This is what the new guidance suggests which is based on the analysis of 11 researches.

If during the HPV test, the results show signs of HPV strains 16 and 18, which are responsible for 70% of cervical cancer, it would be expedient for the patient to submit for a cervical biopsy immediately.

In cases where the test is positive for HPV strains other than 16 and 18, the women should, according to the guidance, undergo a Pap test. A published report can be read in Gynecological Oncology and in two other medical journals.

The new guidance further suggests that the prevailing Pap testing recommendation should be followed for women who are below 25 years of age.

Government supported U.S. Preventive Services Task Force (USPSTF) made a recommendation in 2012 that women who are between 21 and 65 years old should be screened every 3 years using the Pap test. Another recommendation for women between 30 to 65 years old suggested they could choose a combination of Pap and HPV testing to be performed every five years if they opt to.

Although the American College of Obstetricians and Gynecologists (ACOG) had a one of its members working among the new guidance authors, ACOG still believes in the existing recommendation which is similar to that of the USPSTF.

One of the primary consideration according to Huh is there would be many unnecessary testing in the part of women under 20’s using the HPV test since its common for this age group to test positive for this particular virus strain.

With almost 79 million people infected by it, HPV remains as the number one sexually transmitted disease that affects both men and women. Most of the victims are unaware of it because the symptoms are relatively unfamiliar and they are self-limiting.

“We think the balance of procedures and diseases are justifiable,” said Huh, who is also an expert on gynecologic oncology at the University of Alabama in Birmingham.

Dr. George Sawaya and Miriam Kuppermann wrote and editorial published in Obstetrics and Gynecology. They discussed the probable dangers that HPV screening can cause apart from additional testing.


“Such surveillance recently has been found to be associated with significant psychological distress in 39 percent of women,” they write.

Also expressing his concern about   of HPV testing among younger women is Dr. Brent DuBeshter, director of gynecologic oncology at the University of Rochester Medical Center in New York.

“Because it’s so common and disease is so uncommon in that age range, you wouldn’t think it’s a very good age range for that,” said DuBeshter, who wasn’t involved in the new guidance.

In his opinion, DuBeshter added, “HPV testing will eventually overtake Pap tests for cervical cancer screening, but it’s hard to know when, because change in medical practice is usually slow”.

The cost of one HVP test is estimated at $48 Hu said. The Bashter added that it is similar to Pap test

Huh explained that together with biopsy, there are at present three means by which women can undergo cervical cancer testing. He underlined the importance for women to submit to screening.

“These options become completely irrelevant if women don’t come into to be screened,” Huh said.

SOURCE: Gynecologic Oncology, online January 8, 2015.



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