* HUMAN PAPILLOMAVIRUS (HPV) DNA TEST Background epidemiology:
Cervical cancer kills approximately 230,000 women annually, with the vast majority of deaths occurring in developing countries.
Worldwide, cervical carcinoma is the fifth most common cancer-related cause of death among women; in the developing world, it is the leading cause of cancer death in women.
The global distribution of cervical cancer varies, with Africa, Asia, and Latin America bearing a substantial burden of this disease.
Research worldwide has clearly shown that virtually all cervical cancer is caused by human papillomavirus (HPV) infection.
HPV infection is considered a necessary precursor of both cervical cancer and associated precancerous lesions although associated factors like age, persistence of detectable infection, and parity likely influence clinical outcome.
A woman’s HPV status and information on the viral type(s) involved in infection have important clinical significance.
Cervical Cancer is the first most frequent cancer among women in India, and the first most frequent cancer among women between 15 and 44. About 7.9% women in the general population are estimated to harbor ”. (http://bruneiembassy.be)
* Screening for HPV to prevent cervical cancer
HPV infection is most common in younger women. However, the risk for cervical cancer increases until women reach their fifties, probably due to risks associated with persistent HPV infection. Women over 30 years of age who are infected with high-risk HPV may be up to 116 times more likely to develop severe dysplasia than similar, uninfected women.
The direct detection of HPV in cervical specimens may offer an alternative or complement to population-based cytological screening in cervical cancer prevention programs.
Recent studies have demonstrated that HPV test results are more sensitive than Pap smears in detecting high-grade dysplasia in older women.
* Vaccine and HPV: (http://www.cdc.gov/std/hpv/stdfact-hpv-vaccine-young-women.htm)
Two vaccines are available to prevent the human papillomavirus (HPV) types that cause most cervical cancers. Girls and women do not need to get an HPV test or Pap test to find out if they should get the vaccine. However, recommended screening practices such as PAP LBC or HPV test should not change on the basis of HPV vaccination status.
“It is recommended that women continue to be screened for cervical cancer, even after getting all 3 shots of either HPV vaccine.”
Summary of the scientists’ key recommendations for HPV screening (http://ajcp.ascpjournals.org/.)
Cervical cancer screening should begin at age 21.
Women 21 to 29 years old may be screened with Pap test alone every three years.
Women 30 to 65 years old may be screened with Pap and HPV tests (co-testing). In most clinical settings, women ages 30 to 65 years old should undergo co-testing.
* HPV DNA Testing: Synapse
HPV diagnostics rely on molecular technologies that detect HPV DNA in cervical/vaginal samples. Because there are many HPV types with differing oncogenic potential, diagnostic tests must not only detect HPV DNA, they also must determine the type(s) present in each specimen.
Synapse offers a certified HPV screening test using PCR technique. Our Screening can simultaneously genotype (HPV 16 and 18) and screen for 16 high-risk types from patients’ cervical swab, or liquid- based cytology specimen.
Recommendations for Screening and Genotyping: Women who co-test HPV positive but cytology negative should be followed with either repeat co-testing within 12 months or immediate HPV genotype-specific testing for HPV 16 alone or for HPV 16 and HPV 18. If co-testing is repeated at 12 months, women testing positive on either test should be referred to colposcopy; women testing negative on both tests should return to routine screening. (http://ajcp.ascpjournals.org/.)
Synapse offers an HPV DNA screening for multiple “High Risk genotypes” and also simultaneous genotyping for 28 genotypes including HPV 16 / HPV 18, the common genotypes associated with cancer.
“Our Well Women’s screening package for Cervical Cancer includes screening by Liquid based Cytology and Multi Genotype HPV DNA Test from the same LBC vial.”
References:
1. Parkin M. Personal communication, IARC (July 2000).
2. PATH (Program for Appropriate Technology in Health). Preventing cervical cancer in low-resource settings. Outlook 18(1):1–8 (2000). (Available online at http://www.path.org/Files/eol18_1.pdf).
3. Schiffman M, Herrero R, Hildesheim A, et al. HPV DNA testing in cervical cancer screening: results from women in a high-risk province of Costa Rica Journal of the American Medical Association 283:87–93 (2000).
4. Wright TC Jr, Denny L, Kuhn L, et al. HPV DNA testing of self-collected vaginal samples compared with cytologic screening to detect cervical cancer. Journal of the American Medical Association 283(1):81–86 (2000) Franco EL, Rohan TE, Villa LL. Epidemiologic evidence and human papillomavirus infection as a necessary cause of cervical cancer. Journal of the National Cancer Institute 91(6):506–511 (1999).
5. Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. Journal of Pathology 189(1):12–19 (1999).
6. Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. Journal of Pathology 189(1):12–19 (1999).