|March 2009 · Vol. 21, No. 03
UPDATE ON CERVICAL DISEASE
The author revisits his declaration in the 2006 Update that “we’re on the way to ending cervical cancer.” What’s happened in 3 years with screening, HPV testing, and cancer prevention?
The high sensitivity and long-term predictive value of an HPV test ensures that moving to a longer interval isn’t likely to put women at greater risk
The most effective of 10 screening options evaluated was screening with an HPV test first (the most sensitive test) followed by a Pap test (most specific) only on women who have a positive HPV test
Type-specific HPV testing is more complicated than the molecular tests that we use to identify a single virus or bacterium because the test has to identify several HPV types in a single assay
There has been concern that falling HPV antibody levels, particularly against type 18, may indicate reduced protection from high-grade squamous or glandular disease
The most commonly reported minor adverse effect of Gardasil has been syncope—although vasovagal syncope is known to occur after any type of vaccination
Dr. Cox is Director of the Gynecology and Colposcopy Clinic, University of California, Santa Barbara.
Dr. Cox has served as a member of the American Cancer Society (ACS) Cervical Guidelines Committee, the ACS HPV Vaccine Advisory Committee, and the 2001 Bethesda Workshop, and was one of the primary authors of the 2001 ASCCP Consensus Guidelines for the management of women with abnormal cervical cytology and cervical cancer precursors. He is President of the American Society for Colposcopy and Cervical Pathology (ASCCP) and is on the Data and Safety Monitoring Board of the HPV 6, 11, 16, 18 Quadrivalent Vaccine Trial (Merck). He is on the scientific advisory board for GenProbe and has been a consultant to Abbott Laboratories.
In the March 2006 “Update on Cervical Disease,” I began with Prof. Margaret Stanley’s exclamation “It could be the end of the affair with HPV!” That Update covered three major areas that have been nudging us closer to the possibility of someday ending cervical cancer.
I thought it time to revisit those three practical advances to see how we’re doing. As you’ll read, much has happened; one exciting prospect in 2006—human papillomavirus (HPV) vaccination—has become established in everyday practice. On the other hand, primary screening with an HPV plus a Pap test (so-called co-testing) has not yet fulfilled its promise, and type-specific HPV testing for HPV 16 and 18, expected in 2006 to be “just around the corner,” is still … just around that corner.