• 4/17/2003
  • The American Cancer Society

The Food and Drug Administration has approved a new screening test for cervical cancer that could help distinguish women at increased risk from those at very low risk of developing the disease.

Women over age 30 can now receive a test for human papilloma virus, or HPV, at the same time they receive a Pap test. The HPV test, manufactured by Digene Corp. of Gaithersburg, Maryland, is already approved to detect HPV in women with abnormal Pap smears, but until now, it was not approved for screening purposes, before results of the Pap test were known.

Since March, 2000, the test has been used for women whose Pap tests show mild abnormalities that can’t be readily explained, a condition referred to as Atypical Squamous Cells of Unknown Origin, or ASC-US. Until then, such women had to undergo repeated Pap smears every few months in hopes of determining the nature of the abnormal cells – whether they might develop into precancerous lesions or clear up on their own. In some cases, a colposcopy – an examination of the cervix with magnifying binoculars – was used to select areas of the cervix to biopsy, to determine whether the cells were dangerous.

Women with ASC-US Pap results who have negative HPV test results could be reassured that their short term risk of developing cervical cancer was very low, and that they could safely return to the usual screening schedule.

HPV is a family of more than 100 extremely common viruses, of which about 30 are sexually transmitted. Of these, about a dozen “high-risk” varieties are linked to nearly all cervical cancers, and to some cases of vaginal, vulvar, anal, oral, and penile cancers. Other, “low-risk” varieties cause genital warts. In most cases, however, HPV infection causes no symptoms at all, so a person who has HPV might not even know it. In other cases, symptoms of HPV do not appear until years after infection.

According to the Centers for Disease Control and Prevention, 50%-75% of sexually active adults will harbor the virus at some point in their life. In most cases, the immune system defeats the virus with no permanent effects. Sometimes, though, HPV that lingers in the body causes changes in the cervix that are detected with a Pap smear. In rare cases, these changes lead to cancer.

The risk of HPV progressing – causing changes that could lead to cancer – is greater for women over age 30 than for younger women, said Debbie Saslow, PhD, director of breast and gynecologic cancer programs for ACS, which is why the new screening test isn’t recommended for younger women. HPV infections in younger women tend to go away by themselves.

“In a woman over 30,” Saslow said, “if [an HPV infection] hasn’t cleared in a year, you want to do additional testing. It doesn’t mean she’s going to get cancer, but you want to follow her and watch her more carefully” to see if any treatment is needed.

The FDA said women who have an abnormal Pap test and an HPV infection have a 6% to 7% greater risk of developing cervical cancer if they aren’t treated.
Still, cervical cancer is rare even among women who do have an HPV infection. The American Cancer Society estimates about 12,200 new cases of cervical cancer will be diagnosed this year. Screening can help prevent the disease by catching abnormalities in the cervix before they become cancerous.

The Society recommends Pap tests beginning either at age 21 or three years after a woman first has sexual intercourse. Until age 30, screening should be done every year with the regular Pap test or every two years using the newer liquid-based Pap test. After age 30, women who have had three normal Pap tests in a row can wait two or three years for their next Pap.The FDA said the new use of the HPV test is in addition to Pap tests. The HPV test is not a substitute for regular Pap tests.

OCF Note: We have put this news article up because of the strong relationship between non-smokers who develop oral cancers and HPV. There is additional information regarding HPV within the main body of the OCF web site.