|
|
|
|
|
|
|
|
Join
the Discussion
|
|
"I
was diagnosed with HPV 4 years ago. It
wasn't because I had an abnormal pap, it
was that my boyfriend had warts. Anyway, I
just found out my pap came back abnormal.
I am worried about that. I have never had
that happen before. I am very concerned
that I will not be able to have children
and that is very important to me. My
fiancee is very supportive in all of this,
but he doesn't understand how worried I
really am."
GIGI0625
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Bethesda,
MD- February 20, 2001 -- Testing for the human
papillomavirus (HPV) may help doctors and patients decide
what to do about the mildly abnormal and very common Pap
test result known as ASCUS. Findings from a major,
randomized, multicenter study by the National Cancer
Institute (NCI) show that HPV testing is highly sensitive in
identifying which Pap-detected abnormalities require
immediate attention.
A
report on the trial, which is known as the ASCUS/LSIL Triage
Study or ALTS, appears Feb. 21 in the Journal of the
National Cancer Institute. ASCUS and LSIL are acronyms for
two mild abnormalities detected by Pap tests. One objective
of ALTS was to determine whether HPV testing could sort out
which women with ASCUS Pap test results need immediate
attention and which do not.
What to
do about ASCUS (short for atypical squamous cells of
undetermined significance) has been a major issue in
cervical cancer screening. Most of these mild abnormalities
will go away without treatment. But physicians and patients
have had no way to tell which will go away and which
represent more serious conditions -- precancer or cancer --
that need to be treated.
In this
study, HPV testing identified virtually all (96.3 percent)
of the ASCUS abnormalities that needed treatment. "These
results indicate that HPV testing is a viable option for
women and their doctors to consider when deciding what to do
about ASCUS," said NCI's Diane Solomon, M.D., principal
investigator of ALTS.
Although
the HPV test proved highly sensitive, Solomon noted that the
other two approaches to ASCUS remain options to consider.
These are immediate colposcopy (examination with a
magnifying instrument) with biopsy if indicated or follow up
by repeat Pap tests every six months. Patients and
physicians may take several factors into account when
deciding what to do about ASCUS, such as cost and patient
preferences regarding follow-up appointments. The ALTS
investigators plan to analyze the cost effectiveness of the
three options when long-term data from the study become
available.
Data
from ALTS and other cervical screening studies will be
evaluated by medical groups at two upcoming conferences,
which are being convened to consider screening and
management guidelines. NCI is convening the first of these,
the Third Bethesda Workshop, April 30 - May 2, in Bethesda,
Md., to address the diagnosis and reporting of Pap test
results. The second, led by the American Society for
Colposcopy and Cervical Pathology, will develop
evidence-based guidelines for clinical practice. It will
take place in Bethesda, Md., Sept. 6-9.
ALTS
included about 5,000 women with mildly abnormal Pap tests.
About two-thirds had ASCUS and about one-third had the more
definite abnormality called LSIL, or low-grade squamous
intraepithelial lesion. Within each of these categories,
women were assigned randomly to three different groups. One
group had an immediate colposcopy &endash; a procedure in
which a physician examines the cervix through a magnifying
instrument and biopsies any abnormal areas. A second group
had repeat Pap tests. The third group was assigned to HPV
triage. In this triage group, patients' Pap specimens were
tested for HPV types associated with cervical cancer. Those
who were HPV-positive had an immediate colposcopy and biopsy
and those who were HPV-negative did not.
For the
current study, the investigators analyzed the ALTS data from
women who had been referred to colposcopy when they enrolled
in the trial. The colposcopy results were compared to the
results of HPV tests that patients also had on enrollment.
The colposcopy results showed that about 5 percent to 10
percent of women with ASCUS had precancer or cancer and
that, of these women, 96.3 percent had a positive HPV test.
As a corollary, 99.5 percent of women with a negative HPV
test did not have precancer or cancer.
The
investigators conclude that HPV testing can help in deciding
what to do about ASCUS. "A positive test suggests that
precancer or, rarely, cancer may be present -- we found
precancers in 10 percent to 20 percent of ASCUS cases in
which the HPV test was positive," said NCI's co-principal
investigator, Mark Schiffman, M.D. "A negative test provides
strong reassurance that precancer or cancer is not
present."
About
55 percent of women with ASCUS would have been referred to
colposcopy if the HPV test had been used for triage in all
cases. Thus, HPV testing reduced referrals to colposcopy by
about a half compared to immediate colposcopy.
ALTS
was conducted at four major medical centers: the University
of Alabama at Birmingham; the University of Oklahoma in
Oklahoma City; Magee-Womens Hospital of the University of
Pittsburgh Medical Center in Pittsburgh, Pa.; and the
University of Washington in Seattle. It was organized and
funded by the NCI, which is the U.S. government's principal
agency for cancer research.
Press
Release from the National Cancer Institute
Has
your Pap smear ever revealed ASCUS?
![]()
|