Clinical Uses of HPV Testing

Clinical Uses of HPV Testing

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650 cases of sexually-transmitted diseases reported in Dubai in 16 months

650 cases of sexually-transmitted diseases reported in Dubai in 16 months

By Nina Muslim, Staff Reporter
Published: January 27, 2008, 17:24

Dubai: Almost 650 cases of sexually-transmitted diseases were reported in the emirate in the span of 16 months, mostly among young women who caught it from their husbands.

From May 2006 to September 2007, 647 cases were seen at Al Badaa Health Centre, which is where the government-run sexually-transmitted disease (STD) clinic is located.

STD cases have also almost doubled in the four-year period between 2000 and 2003, comprising 3.64 per cent of overall medical cases in 2000 to 5.15 per cent in 2003, the latest analysis available.

The Department of Health and Medical Services (Dohms) released the statistics in the lead up to next week's conference of the International Union against Sexually Transmitted Infections and the Annual International Infectious Disease Congress.

Dr Kamal Faour, head of obstetrics and gynaecology at Maktoum Hospital, and co-chair of the conference, told the press the cases mostly comprised Emirati women in their early 30s.

"I can say the women are victims because they caught the disease from their husbands," he said.

He also said Emirati women comprised the bulk of cases because the statistics only reflected visits to public health facilities, which tend to see more locals than expatriates. The actual figure for STDs in Dubai is unknown.

"The (real) number is more because cases at private clinics and hospitals are not being reported. They are underreported because of the stigma," he said.
Dr. Faour blamed the increase of STDs, most of which are genital warts, genital herpes and gonorrhea, on ignorance and globalisation.

"People do not have awareness of the diseases because STDs are a taboo subject," he said.

"That is why we are holding the conference, to show how serious and dangerous these diseases are so that we can decrease the complications and costs of the disease."
Health complications and consequences of STDs include cancer and infertility, and could cause disability to newborns during delivery. Having an STD also increases one's chances of contracting HIV, the virus which causes AIDS.

The congress will discuss STD rapid diagnostic tests and the ethics of STD reporting. Speakers include officials from World Health Organisation and U.S.-based Centres for Disease Control.

HPV and Men - CDC Fact Sheet

Genital human papillomavirus (HPV) is a common virus. Most sexually active people in the United States (U.S.) will have HPV at some time in their lives. There are more than 40 types of HPV that are passed on during sex. These types can infect the genital areas of men, including the skin on and around the penis or anus.

What are the Health Problem caused by HPV in Men?
Most men who get HPV (of any type) never develop any symptoms or health problems. But some types of HPV can cause genital warts. Other types can cause penile cancer or anal cancer. The types of HPV that can cause genital warts are not the same as the types that can cause penile or anal cancer.Anal cancer is not the same as colorectal cancer. Colorectal cancer is more common than anal cancer, but it is not caused by HPV.

How common are HPV related health related problems in Men?

About 1% of sexually active men in the U.S. have genital warts at any one time.
Penile cancer is rare, especially in circumcised men. In the U.S., it affects about 1 in every 100,000 men. The American Cancer Society (ACS) estimated that about 1,530 men would be diagnosed with penile cancer in the U.S. in 2006.
Anal cancer is also uncommon—especially in men with healthy immune systems. According to the ACS, about 1,900 men will be diagnosed with anal cancer in the U.S. in 2007.


Some men are more likely to develop HPV-related diseases than others:

Gay and bisexual men are 17 times more likely to develop anal cancer than heterosexual men.
Men with weak immune systems, including those who have human immunodeficiency virus (HIV), are more likely than other men to develop anal cancer. Men with HIV are also more likely to get severe cases of genital warts that are hard to treat.

What are the Sign & Symptoms?

Among men who do develop health problems, these are some of the signs to look for:

Signs of genital warts:
One or more growths on the penis, testicles, groin, thighs, or anus.
Warts may be raised, flat, or cauliflower-shaped. They usually do not hurt.
Warts may appear within weeks or months after sexual contact with an infected person.
Signs and symptoms of anal cancer:
Sometimes there are no signs or symptoms.
Anal bleeding, pain, itching, or discharge.
Swollen lymph nodes in the anal or groin area.
Changes in bowel habits or the shape of your stool.
Signs of penile cancer:
First signs: changes in color, skin thickening, or a build-up of tissue on the penis.
Later signs: a growth or sore on the penis. It is usually painless, but in some cases, the sore may be painful and bleed.
There may be no symptoms until the cancer is quite advanced.

How do men get HPV?

HPV is passed on through genital contact –most often during vaginal and anal sex. Since HPV usually causes no symptoms, most men and women can get HPV – and pass it on - without realizing it. People can have HPV even if years have passed since they had sex.

Is there a test for HPV in Men?
Currently, there is no test designed or approved to find HPV in men. The only approved HPV test on the market is for women, for use as part of cervical cancer screening. There is no general test for men or women to check one’s overall “HPV status.” But HPV usually goes away on its own, without causing health problems. So an HPV infection that is found today will most likely not be there a year or two from now.

REMEMBER: HPV is very common in men and women. Most men with HPV will never develop health problems from it. Finding out if you have HPV is not as important as finding out if you have the diseases that it can cause. Scientists are still studying how best to screen for penile and anal cancers in men who may be at highest risk for those diseases (see below).

Is there a test to find genital warts?
Most of the time, you can see genital warts. Some doctors may use a vinegar solution to help find flat warts—but this test can sometimes wrongly identify normal skin as a wart.

Is there a test to screen for HPV-related cancers in men?
Screening tests can find early signs of disease in people who are not yet sick. Screening tests for penile or anal cancer are not widely recommended.

Some experts recommend yearly anal Pap tests for gay, bisexual, and HIV-positive men, since anal cancer is more common in these groups. This test can find abnormal cells in the anus that could turn into cancer over time. If abnormal cells are found, they can be removed. CDC does not recommend anal Pap tests because there is not enough research to show that removing abnormal anal cells actually prevents anal cancer from developing in the future. More studies are needed to understand if anal Pap tests and treatment of abnormal cells prevent anal cancer in men.

You can check for any abnormalities on your penis, scrotum, or around the anus. See your doctor if you find warts, blisters, sores, ulcers, white patches, or other abnormal areas on your penis—even if they do not hurt.

Is there any cure or treatment?
There is no treatment or cure for HPV. But there are ways to treat the health problems caused by HPV in men.

Genital warts can be treated with medicine, removed (surgery), or frozen off. Some of these treatments involve a visit to the doctor. Others can be done at home by the patient himself. No one treatment is better than another. But warts often come back within a few months after treatment—so several treatments may be needed. Treating genital warts may not necessarily lower a man’s chances of passing HPV on to his sex partner. Because of this, some men choose not to treat genital warts. If they are not treated, genital warts may go away on their own, stay the same, or grow (in size or number). They will not turn into cancer or threaten your health.

Penile and anal cancers can be treated with new forms of surgery, radiation therapy, and chemotherapy. Often, two or more of these treatments are used together. Patients should decide with their doctors which treatments are best for them.

Are there ways to lower chances of getting HPV?
Because HPV is so common and usually invisible, the only sure way to prevent it is not to have sex. Even people with only one lifetime sex partner can get HPV, if their partner was infected with HPV. Condoms (used all the time and the right way) may lower your chances of passing HPV to a partner or developing HPV-related diseases. But HPV can infect areas that are not covered by a condom—so condoms may not fully protect against HPV.

I heared new HPV vaccine, Can it help me?
The new HPV vaccine was developed to protect against most cervical cancers and genital warts. At this point, it is only licensed to be used in girls/women, ages 9-26 years. Studies are now being done to find out if the vaccine is also safe in men, and if it can protect them against genital warts and certain penile and anal cancers. The FDA will consider licensing the vaccine for boys and men if there is proof that it is safe and effective for them.

I just found out that my partenar has HPV!!!!
What does it mean for my health? Partners usually share HPV. If you have been with your partner for a long time, you probably have HPV already. Most sexually active adults will have HPV at some time in their lives. Men with healthy immune systems rarely develop health problems from HPV. But you should check regularly for any abnormalities on your penis. If you have a weak immune system or HIV, ask your doctor about checking for anal and penile cancers.

If your partner is new, condoms may lower your chances of getting HPV or developing HPV-related diseases. But not having sex is the only sure way to avoid HPV.

What does it mean for our relationship?
A person can have HPV for many years before it is found or causes health problems. So there is no way to know if your partner gave you HPV, or if you gave HPV to your partner. HPV should not be seen as a sign that you or your partner is having sex outside of your relationship.

80 percent of sexually active female teens infected with HPV

Exceeding rates observed in previous research, a new study found four out of five sexually active adolescent women infected with human papillomavirus, a virus linked to cervical cancer and genital warts. Darron R. Brown and colleagues of Indiana University School of Medicine studied 60 adolescent women, ages 14 to 17, at three primary care clinics in Indianapolis. They reported their results in the Jan. 15 issue of The Journal of Infectious Diseases, now available online.

From IDSA:

Very High Prevalence of Virus Linked to Cervical Cancer Found in Adolescent Women

Exceeding rates observed in previous research, a new study found four out of five sexually active adolescent women infected with human papillomavirus, a virus linked to cervical cancer and genital warts. Darron R. Brown and colleagues of Indiana University School of Medicine studied 60 adolescent women, ages 14 to 17, at three primary care clinics in Indianapolis. They reported their results in the Jan. 15 issue of The Journal of Infectious Diseases, now available online.

Human papillomavirus (HPV) infection is a common sexually transmitted infection whose effects may range from asymptomatic carriage of the virus to genital warts to cervical cancer. In this study, 95 percent of the subjects were sexually active, and the median number of sexual partners was two. Eighty-five percent were African American, 11 percent were Caucasian, and 3 percent were Hispanic.

Participation in the study involved quarterly visits to a primary care clinic for a cervical swab test and up to five 3-month diary collection periods during which subjects recorded their sexual behavior daily and performed self-vaginal swabbing weekly. Each woman participated in the study for an average of two years. Brown and colleagues collected a total of about 2,100 swab specimens adequate for analysis of HPV infection.

During the course of the study, 49 of 60 subjects tested positive for HPV infection. In addition to an 82 percent prevalence rate, the investigators identified several characteristics of the HPV infections detected. Many of the HPV-positive study participants were infected with not just one, but multiple, HPV types. The mean number of types per participant was about five. Among these different types, a substantial number were those associated with an increased risk for cervical cancer: 39 percent of the swab specimens were classified as high-risk types and 20 percent as low-risk. Clinically, 37 percent of the study participants had at least one abnormal result for cervical examination during the study period.

Brown and colleagues hypothesized that relative to earlier research, the high cumulative prevalence of HPV infection in their study was primarily a result of the high number of swab specimens obtained from each study participant. Many infections were detectable for only a few weeks, and might have been missed had specimens been obtained at longer intervals of time. They also attributed the high prevalence to their use of an assay that detects more HPV types than some other assays do, and to the at-risk nature of this particular study population.

Distinguished by its long follow-up and frequent testing procedures, this study confirms previous findings that HPV infection is common in sexually active adolescent women. ''We hope the results of our research increase our understanding of HPV infection in this population,'' said Dr. Brown, ''and help others design effective interventions to prevent infection in adolescent women.''

STD Testing

Sexually transmitted diseases are common in the U.S., with the Center for Disease Control and Prevention (CDC) estimating 19 million new infections among young people every year. If you are a sexually active person, it is vitally important to practice safer sex each and every time you are intimate. Going for STD testing when you decide to become intimate with someone new is also imperative to staying sexually healthy. To understand a bit more about what happens when you get a STD test, here is a helpful overview of the different tests done for the more common STDs.

Human Papilloma Virus
Every year, about 6.2 million Americans are infected with the Human Papilloma Virus also known as genital warts. There are two types of HPV virus, the "low-risk" type and the "high-risk" type. People infected with low-risk HPV are more likely to develop genital warts, which can be treated but not cured. Those with a high-risk HPV infection are less likely to develop HPV symptoms but have a significant risk of developing cervical cancer or some other form of genital cancer.

People infected with HPV strains that lead to genital herpes may be able to have their infection diagnosed through a visual inspection. During your exam, your doctor will examine your genitals for any signs of genital warts. However, genital warts are not always visible to the naked eye. Therefore, your health care provider may also swab the area with acetic acid, which will help make small warts visible.

Because the HPV strains linked to cervical cancer typically do not produce symptoms, it is also important to have regular pap tests done, which will test your cervical cells for signs of HPV infection.

Crabs or Pubic Lice
Pubic lice, or crabs, are a common sexually transmitted disease. Some symptoms of pubic lice include itchiness of the infected area or visible lice. Crabs are diagnosed with a physical examination of the infected area. However, because of the intense itching that these parasites cause, you will likely be aware of the problem before you get yourself to a doctor.

Once at the doctors, she will do a visual examination of the area, looking for the actual lice as well as nits, which are clusters of lice eggs. Your doctor may also examine other areas of your body in order to assess whether the lice have migrated. Treatment of crabs is usually washing with over-the-counter or prescription shampoos.

Genital Herpes
There are two types of genital herpes, herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). According to the CDC, most herpes infections are caused by HSV-2. Many people do not know when they are infected because there may be little to no symptoms of herpes present.

If you are experiencing a herpes outbreak, a visual examination of the area is sometimes enough to make a diagnosis. However, herpes sores can be mistaken for other types of infections or may not be present. Therefore, viral and blood tests are generally thought to be the most effective means of testing for herpes. While there is no cure for herpes, a variety of herpes treatment are available.


Blood, Urine or Cell Samples

Most STDs can be conclusively diagnosed through the use of blood, urine or cell testing.

Chlamydia
It has been estimated that as much as 2.8 million Americans are infected with chlamydia while in 2004 alone, more than 900,000 chlamydia infections were reported to the Centers for Disease Control and Prevention. In women, symptoms of chlamydia are typically absent or mild, making it difficult to notice the signs right away.

To diagnose chlamydia in women, your health care provider will do a pelvic exam, during which time she will examine your genitals for signs of infection. Additionally, she will take a cervical swab, which is much like a pap smear. This swab will then be sent to a lab, where specialists will look for signs of the bacteria that cause chlamydia. If you are found to be infected, your doctor will prescribe an effective chlamydia treatment.

Gonorrhoea
The CDC reports that every year more than 700,000 people are infected or re-infected with gonorrhea. Symptoms of gonorrhea include green or yellow discharge from the genitals as well as abdominal pain.

Gonorrhea is diagnosed through both a physical examination and a culture test. For the culture test, your health care provider will take a sample of any discharge that is present. This sample will then be sent to a lab and left to culture for two days. After this time, the sample will be examined under a microscope for the presence of bacteria.

It is also possible to perform a urine test for gonorrhea. However, this test is not as accurate as a culture test and is best used to rule out the infection. Once diagnosed, your doctor can prescribe the appropriate treatment.

Syphilis
In 2002, over 32,000 cases of syphilis were reported in the U.S. Although they may be not be immediately apparent, some of the signs of syphilis include sores, skin rashes and internal organ damage. Because syphilis occurs in stages, testing for the infection varies from stage to stage.

During the initial stages of the infection, a diagnosis will be made through both a physical exam, during which time your doctor will look for chancres, as well through a fluid sample from the chancres. However, it is necessary to have chancre sores visibly present on your body in order to perform this diagnosis.

Testing in the second stage of syphilis will involve your health care provider checking your lymph glands and for signs of a bodily rash. A blood test will also be ordered, which will look for antibodies to the syphilis bacteria. A positive diagnosis will be confirmed through a second test.

People in the late stages of syphilis infection will have the Cerebrospinal Fluid Test performed. For this test, a sample of your spinal fluid will be collected and assessed to determine the extent of your infection. Syphilis can be treated through the use of penicillin.

Trichomoniasis
Caused by the Trichomonas Vaginalis parasite, trichomoniasis, or trich, is a common sexually transmitted disease. Many people infected have no trichomoniasis symptoms or they mistake their infection for a yeast infection. However some symptoms include lower abdominal pain or unusual discharge from the genitals.

To test for trich, your doctor will perform a pelvic exam, during which time he will feel for any sores on your cervix. Additionally, a cervical swab will be taken and this sample will be combined with a salt solution before being examined under a microscope to check for the presence of the parasite.

Human Immunodeficiency Virus (HIV)
A person infected with HIV may initially have no symptoms. Signs of HIV in the more advanced stages include rapid weight loss, recurring fevers, and unusual blemishes in the mouth or in the throat.

HIV can be tested by a blood sample test called the HIV antibody test. For this test, a sample of blood will be drawn and then sent to a lab, where specialists will look for the presence of HIV antibodies in your system. If antibodies are identified, you are considered to be HIV positive.

Because it can take up to three months for the HIV infection to become apparent in your system, it is often recommended to wait to test if you think you have been exposed. However, if you choose, you can be tested as soon as three weeks after exposure although you will need to be re-tested again three months later if you receive a negative test the first time around.

HIV can be treated through the use of antiretroviral drugs. There is no cure for HIV, though, and this infection almost always leads to the development of AIDS and is fatal. The best way to deal with HIV is to avoid it all together through abstinence or safe sexual practices.

Recent facts and statistics for HPV | How to test for HPV | side effects of HPV vaccine

HPV Facts


HPV is the short form for Human Papillomavirus. HPV is a family of very common viruses that cause almost all cervical cancers, plus a variety of other problems like common warts, genital warts and plantar warts. HPV also causes cancers of the vulva, vagina, anus, and cancers of the head and neck. Both women and men become infected with HPV types that cause cervical cancer through sexual intercourse and sexual contact.
Are there different kinds of HPV?

There are over 100 strains of the HPV virus, with over 35 known different HPV types that infect the genital tract. At least 15 of these can lead to cervical cancer. The most common cancer-causing types of the virus are 16 and 18. This is important to know because these two types alone cause about 70% of all cervical cancer. The cervical cancer vaccine protects against these two types 100% of the time.
How does HPV work?

An HPV infection rarely leads to cervical cancer. In most women infected with HPV, the cells in the cervix return to normal after the body’s immune system destroys the HPV infection without the woman ever having any signs or symptoms of the HPV. However, some HPV infections do not go away and may remain present in the cervical cells for years. Long-standing infection can lead to changes in the cells that can progress to cancer. It is these cell changes that a Pap test can detect. When the HPV virus is not treated, the cells will continue to change until they become cervical cancer. Because it can last so long in your body before any cell changes occur, it is difficult to know who transmitted the HPV to you. Don’t make assumptions and blame your current partner.
How Common Is HPV?

HPV is the most common sexually transmitted infection. It is common in all sexually active people. At least 70% of sexually active people will get HPV at some time in their lives. HPV is most common in young women and men who are in their late teens and early 20s. The CDC estimates that there are 6.2 million new infections each year in the United States. Since it is so common, there is nothing to be ashamed about. If you are diagnosed with HPV, talk to your health care provider about it. Get answers to your questions.
HPV Facts
What are the signs and symptoms of HPV?

Most women and men do not know when they are infected with HPV. There are usually no symptoms. Anyone who has ever had genital contact with another person, not just sexual intercourse, can get HPV. Both men and women can get it—and pass it on to their sex partners without even realizing it. An abnormal Pap test result is usually a woman’s first clue of an infection, but most HPV-infected women do not ever have an abnormal Pap test result. HPV is not HIV or Herpes. They are different viruses with different symptoms.
How can I protect against HPV infection?

The only sure way to prevent HPV infection is to abstain from all sexual activity. Sexually active adults can reduce their risk by being in mutually faithful relationship with someone who has had no other or few sex partners, or by limiting their number of sex partners. But even persons with only one lifetime sex partner can get HPV if their partner has had previous partners.
Do condoms protect against HPV?

Recent studies suggest that condoms provide some protection against the HPV infection. However, since condoms do not cover all areas of the body involved in sexual contact that can be the source of the spread of HPV, they do not offer complete protection. However, in addition to HPV protection, they do reduce the risk of HIV and other sexually transmitted disease when used all the time and in the right way.
What are the factors that increase your risk for HPV?

You are more likely to get HPV if you smoke, if you start having sex at a young age, or if you have many sex partners or your sex partner has many sex partners.
How do I know if I have HPV?

The only way to know if you have an HPV infection is if your health care provider tests you for the virus. This may be done directly from the Pap test container or by using an additional swab at the time of the Pap test. Your health care provider may or may not perform the HPV test, depending on many factors including your age and risk factors. The only way to tell if a cancer-causing type of HPV infection has caused the cells in your cervix to change is to have a Pap test. Signs of an HPV infection may appear weeks, months or years after the first infection, which is why it is important to have regular Pap tests and HPV tests as recommended by your health care provider.
HPV Facts
Why isn’t there an HPV test for men?

The diseases that HPV causes in women do not happen in men. So the test results will not be helpful for a man.
I’ve been told I have HPV. How do I know if or when it has cleared up?

Most HPV infections will clear on their own. Those women that have long-standing HPV infections are more at risk for developing cervical precancerous lesions or cervical cancer. There is no shot or pill that is available to clear your HPV infection. Hopefully, as in most women, your body’s immune system will clear your HPV infection on its own. If your health care provider is performing an HPV test on you, and your test is negative, it is likely that your infection cleared.
Should I get an HPV Test?

The HPV test detects high-risk-or cancer causing types of HPV that can cause changes in your cervical cells. However, this test cannot tell you the exact type of high-risk HPV. Women 30 years of age and older can have both the Pap test and the HPV test for cervical cancer screening. The HPV test can also be used to help understand the meaning of a borderline abnormal Pap test. In that situation, your health care provider may do an HPV test to find out more about the abnormal cells. However, if your Pap test shows a definite pre-cancerous abnormality, an HPV test is not needed. Virtually all of these changes are caused by HPV. You can assume the HPV test will be positive.
Is there a cure for HPV?

Currently, there is no cure for the virus. There are treatments for the cervical changes that HPV can cause. If your Pap and HPV tests show that cells in your cervix have changed, you should discuss treatment options with your health care provider.
Can you prevent HPV?

Good news! There is now a vaccine to prevent HPV infection. Girls and women age 9-26 can protect themselves from HPV and cervical changes related to HPV by getting the cervical cancer vaccine.
How does the vaccine work?

The cervical cancer vaccine takes prevention a giant leap forward by blocking the first step along the pathway to cervical cancer, HPV infection. The vaccine is given in the arm or thigh three times—at the first visit, two months later and four months after that. The best protection is achieved after all three shots are given. It is not known at this time whether booster shots will be needed later. Studies show that the vaccine is extremely safe. There are no live viruses in the vaccine. The most common side effects are redness and soreness where the shot was given. Headaches (like when you have a cold or fever) are also common. Fever can also occur. Over the counter pain and fever medications will help if you have symptoms. As with any new medication, safety issues will continue to be monitored.

HPV screening may be better than Pap test

NEW YORK (CBS) ― Cervical cancer claims the lives of an estimated 4,000 Americans each year, with many of those deaths preventable with earlier detection.

But new research says the most popular screening test may not be the most effective.

HPV stands for human papilloma virus, and it’s the most common sexually transmitted infection.

Early detection of the virus is crucial, since HPV leads to cervical cancer in women.

Until now the pap smear has been the gold standard of screening, but a landmark new study says it may no longer be the best.

Jodi McKinney is back on her feet after a simple test helped her beat cervical cancer.

“When they first told me that I had cancer cells, I was devastated,“ McKinney says.

The 43-year-old got the news when her doctor ran a test for the HPV virus along with her pap smear.

The pap smear was negative, but the HPV test came up positive, allowing doctors to diagnose the cancer at an earlier stage.

“I was about to avoid having the hysterectomy, the chemo, the radiation,“ McKinney says.

The HPV virus causes nearly 90 percent of cervical cancers, and a new study says that routine HPV testing for women over 30 could save millions of lives.

“The pap smear is not as sensitive as the HPV,“ general practitioner Dr. Steven Lamm says. “So there are a lot of women who might be negative on the pap smear, and then turn out to actually have cervical cancer.“

The study of 130,000 women was done in India, and was partly funded by the maker of the HPV test.

The results are so clear that the National Cancer Institute says HPV testing should eventually replace pap smears as the best early detection method.

“This will be the new standard,“ Dr. Lamm says.

Gynecologists are now being urged to make HPV testing part of the annual exam, along with the pap test.

“If your doctor doesn’t offer it to you, please ask for it,“ McKinney says. “Insist on it.“

McKinney, a mother of five, is now cancer-free – and looking forward to watching her family grow.

It should be relatively simple for doctors to add the HPV test to the annual gynecological exam – it uses the same tissue sample taken during the regular pap test, so it does not require any additional procedures or cause any additional discomfort for the patient.

HPV Test Better than Pap Smear for Detecting Cervical Cancer, Study Finds - Health News |

HPV Test Better than Pap Smear for Detecting Cervical Cancer, Study Finds

A relatively new screening test for cervical cancer may be twice as accurate as the traditional pap smear in detecting the disease, according to a new study.

The new test could replace the 50-year-old Pap in a matter of years, experts say. And there's a bonus for women: They won't need a screening test as often.

The HPV test, which looks for the virus that causes cervical cancer, correctly spotted 95 percent of the cancers. The Pap test, which checks for abnormal cells under a microscope, only found 55 percent, according to researchers at McGill University in Montreal, who published their findings in Thursday's New England Journal of Medicine.

"We've had the Pap test for over 50 years and it's high time it be replaced by technology that's more robust," said Eduardo Franco, director of McGill's division of cancer epidemiology, who led the study.

Franco said some feared the HPV test would result in more false alarms, causing anxiety and requiring more follow-up testing. In the study, there were only slightly more false positives for the HPV tests (6 percent) than the Pap smears (3 percent).

HPV, or human papilloma virus, is a common sexually transmitted disease. Infections are mostly in young women and most go away on their own. The HPV test looks for the high-risk viruses that can cause cervical cancer if the infection persists. Like the Pap, it uses cells scraped from the cervix, the lower part of the uterus.

Because the Pap test misses about half of the cases, doctors use frequent testing to catch the slow developing cancer at its earliest, most treatable stages.

The HPV test has been available in the U.S. since 2000 and was first used for inconclusive Pap tests. Now women over 30 can get a HPV test - but only along with a Pap - and wait three years to be tested again if both tests are negative.

More recently, scientists have been studying whether the HPV test can be used alone and whether it can prolong the intervals between exams. Debbie Saslow, director of breast and gynecologic cancer for the American Cancer Society, said evidence from a number of studies supports using the HPV test in place of a Pap.

"Overall, I don't think there's any doubt that HPV testing has a lot of advantages over the Pap test," she said.

Saslow said there are still issues to be resolved, and federal approval needed, but "it's definitely coming." She said experts expect that to happen sometime in the next decade.

A Swedish study also in the journal compared Pap with HPV testing to Pap alone in 12,527 women in their 30s. They found the combo test detected precancerous lesions or cancer earlier than the Pap test alone.

The Canadian study, which was government-funded, included 10,154 women ages 30 to 69 in Montreal and St. John's, Newfoundland. The women got both tests. Still to be determined is the best way to start using the HPV test by itself and what follow-up action to take after positive results, the researchers said.

The HPV test is more expensive: In the U.S., Medicare pays about $50 for the HPV test and $15 to $28 for a Pap test.

Some of the researchers have received fees or grants from drug makers including Merck Frosst Canada Ltd., a subsidiary of Merck & Co., which makes a cervical cancer vaccine. One has stock in Digene Corp., which developed the only approved HPV test.

Franco emphasized that girls who have been vaccinated against HPV will still need to be screened because the vaccine only protects against some of the cancer-causing strains.

Dr. Carolyn D. Runowicz, who wrote a journal editorial, noted that the two studies used a different kind of Pap test, not the liquid-based technology used in the U.S, which may be more sensitive The results of a British study that used liquid Pap are due to be presented in November.

"We're not ready for prime time. We're moving in that direction. But we're not there yet," said Runowicz, a former president of the American Cancer Society.

Human Papillomavirus (HPV) Test - Test Overview - Health.com

Human Papillomavirus (HPV) Test

A human papillomavirus (HPV) test is done to find a high-risk HPV infection in women. HPV is a sexually transmitted disease (STD). An HPV test checks for the genetic material (DNA) of the human papillomavirus. Like a Pap test, an HPV test is done on a sample of cells collected from the cervix Click here to see an illustration.

There are many types of HPV. Some types cause warts that you can see or feel. Other types do not cause any symptoms. Most people do not know they have an HPV infection.

This test will identify whether a high-risk type of HPV is present. In women, high-risk types of HPV (such as types 16, 18, 31, and 45) cause changes in the cells of the cervix that can be seen as abnormal changes on a Pap test. Abnormal cervical cell changes may resolve on their own without treatment. But some untreated cervical cell changes can progress to serious abnormalities and may lead to cervical cancer over time if it is not treated.

For information about treatment of abnormal cervical cell changes seen on a Pap smear, see the topic Abnormal Pap Test.

Although HPV is found in both men and women, this test is not used on men. Also, your doctor can usually diagnose visible genital warts with a physical exam, so this test is not used to diagnose genital warts caused by low-risk types of HPV.

Seminar held on Cervical Cancer Management Strategies

Over 75 doctors from the UAE attended a Continuous Medical Education Seminar (CME) proudly organised by Eastern Biotech & Life Sciences on Management Strategies of Cervical Cancer & Sexually Transmitted Disease.

Cervical cancer is the second most common cancer and cause of death in women worldwide. In the UAE it is on the rise with reported cases tripling in 2005. Worldwide there are an estimated 650 deaths, which is the equivalent of 10 women in the Middle East dying every day. HPV (Human Papilloma Virus) is the cause of 99.7% of cervical cancer cases and HPV Genotypes 16 and 18 causes approximately 70% of cervical cancers worldwide. Thus it is important to clearly identify those women at increased risk of developing cervical cancer at an early stage.

The seminar & workshop was held at Rotana Towers Hotel, Dubai on 1^st July 2009. It was organised by Eastern Biotech & Life Sciences, supported and sponsored by Dubiotech, Glaxo smithcline & Life Cell International. It was supported by the Ministry of Health, United Arab Emirates and has been formally granted 4.0 CME credit points. Seminar was Chaired by Dr. Marco Baccanti, Executive Director of DuBiotech, Dubai.

The primary objective of the seminar & workshop is to raise awareness of cervical cancer among the clinicians and how it can be prevented. In seminar also discussed by eminent speaker about combination of liquid based cytology using the Digene Hybrid capture 2 techniques and the latest DNA based HPV detection technologies utilised for the prevention of cervical cancer.

“HPV infection is very common in sexually active men and women. It is usually transient and results only in mild cytological abnormalities. About 80 % of women between 19 and 30 years clear this infection within months or years, but in some cases persistent infection of high risk HPV can lead to the development of cervical cancer said Dr. Rihab from Mitera Clinic, Duai.” She discussed on The Need of Clinical Education to Raise an Awareness of HPV Screening and Cervical Cancer Prevention.

Dr. Sanjida from Research Director for Eastern Biotech & Life Sciences raised the issue of Sexually Transmitted Infections (STI) screening program and enlightens the available high end techniques for other STI such as HIV, HCV, HBV, Chlamydia, HSV1/2, Syphilis, Gonorrhoea etc along with HPV.

The need for additional efforts for detection of cervical cancer and with FDA approved technique was also highlighted by Dr. Dinesh Gupta from National Clinical Reference Laboratory, New Delhi India. Dr. Gupta discussed on Opportunistic Screening for Cervical Precancer Lesions. According to him relevant diagnostic tools for prevention and diagnosis of cervical cancer are already available:
- The traditional PAP smear and its variant, the Liquid Based Cytology for the detection of cervical abnormalities.

- The HPV DNA and which together with cytology tests increases the sensitivity and/or specificity of the cytology exam improving management and follow-up of high risk women.

Vaccination against HPV of young women is now available and also consists in a new powerful weapon against cervical cancer. Dr. Rima AbuOmar from Al Zahra Hospital, Sharjah said Vaccine is the Primary Protection Against Cervical Cancer.

About Eastern Biotech & Life Sciences:
Eastern Biotech & Life Sciences is a UAE based Biotechnology Company under the Dubai Biotechnology and Research Park, DUBIOTECH, Dubai. The company has a vision to prevent morbidity and mortality among individuals and families with or at risk of genetic, congenital, and/or familial disorders. Eastern Biotech provides quality screening, education and family-centered comprehensive services for the Middle Eastern people. The company is also offering HC2 Hybrid capture technique for detection of HPV in combination with Liquid based cytology and other STI on same sample.

For more information, please visit Eastern Biotech & Life Sciences website or contact:
Pankaj Sohaney, Manager Marketing & Business Development (Tel. +00971 4 3692061)

www.easternbiotech.ae

info@easternbiotech.com

HPV Vaccine Information For Young Women

There is now a vaccine that prevents the types of genital human papillomavirus (HPV) that cause most cases of cervical cancer and genital warts. The vaccine, Gardasil®, is given in three shots over six-months. The vaccine is routinely recommended for 11 and 12 year old girls. It is also recommended for girls and women age 13 through 26 who have not yet been vaccinated or completed the vaccine series.

Why the HPV vaccine is important

Genital HPV is a common virus that is passed on through genital contact, most often during sex. Most sexually active people will get HPV at some time in their lives, though most will never even know it. It is most common in people in their late teens and early 20s.

There are about 40 types of HPV that can infect the genital areas of men and women. Most HPV types cause no symptoms and go away on their own. But some types can cause cervical cancer in women and other less common genital cancers— like cancers of the anus, vagina, and vulva (area around the opening of the vagina). Other types of HPV can cause warts in the genital areas of men and women, called genital warts. Genital warts are not a life-threatening disease. But they can cause emotional stress and their treatment can be very uncomfortable.

Every year, about 12,000 women are diagnosed with cervical cancer and almost 4,000 women die from this disease in the U.S.

About 1% of sexually active adults in the U.S. (or 1 million people) have visible genital warts at any point in time.
Who should get the HPV vaccine

The HPV vaccine is recommended for 11 and 12 year-old girls.1 It is also recommended for girls and women age 13 through 26 years of age who have not yet been vaccinated or completed the vaccine series.

1 Note: The vaccine can also be given to girls 9 or 10 years of age.

Will sexually active females benefit from the vaccine?

Ideally females should get the vaccine before they become sexually active, when they may be exposed to HPV. Females who are sexually active may also benefit from the vaccine, but they may get less benefit from it. This is because they may have already gotten an HPV type targeted by the vaccine. Few sexually active young women are infected with all HPV types covered by the vaccine so they would still get protection from those types they have not yet gotten. Currently, there is no test available to tell if a girl/woman has had HPV in the past, or which types.

Can pregnant women get the vaccine?

The vaccine is not recommended for pregnant women. There has been limited research looking at vaccine safety for pregnant women and their unborn babies. So far, studies suggest that the vaccine does not cause health problems for pregnant women or their developing child. But more research is still needed. For now, pregnant women should wait until their pregnancy is over before getting the vaccine. If a woman finds out she is pregnant after she has started getting the vaccine series, she should wait until her pregnancy is over before finishing the three-dose series.

Should girls/women be screened for cervical cancer before getting vaccinated?

No. Girls/women do not need to get an HPV test or Pap test to find out if they should get the vaccine. Neither of these tests can tell the specific HPV type(s) that a woman has (or has had in the past), so there’s no way to know if she has already had the HPV types covered by the vaccine.

Why is the HPV vaccine only recommended for girls/women through age 26?

The vaccine has been widely tested in girls/women 9 through 26 years of age. New research is being done on the vaccine’s safety and efficacy in women older than 26 years of age. The FDA will consider licensing the vaccine for these women when there is enough research to show that it is safe and effective for them.
What about vaccinating boys and men?

We do not yet know if the vaccine is effective in boys or men. It is possible that vaccinating males will have health benefits for them by preventing genital warts and rare cancers, such as penile and anal cancer. It is also possible that vaccinating boys/men will have indirect health benefits for girls/women. Studies are now being done to find out if the vaccine works to prevent HPV infection and disease in males. When more information is available, this vaccine may be licensed and recommended for boys/men as well.
Effectiveness of the HPV Vaccine

This vaccine targets the types of HPV that most commonly cause cervical cancer and genital warts. The vaccine is highly effective in preventing those types of HPV and related diseases in young women.

The vaccine is less effective in preventing HPV-related disease in young women who have already been exposed to one or more HPV types. That is because the vaccine does not treat existing HPV infections or the diseases they may cause. It can only prevent HPV before a person gets it.
How long does vaccine protection last? Will a booster shot be needed?

Research suggests that vaccine protection will last a long time. More research is being done to find out if women will need a booster vaccine many years after getting vaccinated to boost protection.

What does the vaccine not protect against?

The vaccine does not protect against all types of HPV— so it will not prevent all cases of cervical cancer. About 30% of cervical cancers will not be prevented by the vaccine, so it will be important for women to continue getting screened for cervical cancer (regular Pap tests). Also, the vaccine does not prevent other sexually transmitted infections (STIs). So it will still be important for sexually active persons to lower their risk for other STIs.

Will girls/women be protected against HPV and related diseases, even if they don’t get all three doses?

It is not yet known how much protection girls/women would get from receiving only one or two doses of the vaccine. For this reason, it is very important that girls/women get all three doses of the vaccine.
Safety of the HPV vaccine

This vaccine has been licensed by the FDA and approved by CDC as safe and effective. It was studied in thousands of females (ages 9 through 26 years) around the world and its safety continues to be monitored by CDC and the FDA. Studies have found no serious side effects. The most common side effect is soreness in the arm (where the shot is given). There have recently been some reports of fainting in teens after they got the vaccine. For this reason, it is recommended that patients wait in their doctor’s office for 15 minutes after getting the vaccine.
Cost and Paying for the HPV vaccine

The retail price of the vaccine is about $125 per dose ($375 for full series).

Is the HPV vaccine covered by insurance plans?

While some insurance companies may cover the vaccine, others may not. Most large insurance plans usually cover the costs of recommended vaccines.

How can I get help paying for the vaccine?

Children age 18 and younger may be eligible to get vaccines, including the HPV vaccine, for free through the Vaccines for Children (VFC) program if they are: Medicaid eligible; uninsured; or American Indian or Alaska Native. Doctors may charge a small fee to give each shot. However VFC vaccines cannot be denied to an eligible child if the family cannot afford the fee.

Some states also provide free or low-cost vaccines at public health department clinics to people without health insurance coverage for vaccines. Contact your State Health Department to see if your state has such a program.
What vaccinated girls/women need to know
Will girls/women who have been vaccinated still need cervical cancer screening?

Yes, women will still need regular cervical cancer screening (Pap tests) because the vaccine will NOT protect against all HPV types that cause cervical cancer. Also, women who got the vaccine after becoming sexually active may not get the full benefit of the vaccine if they had already acquired HPV.
Other ways to prevent HPV and Cervical Cancer

Another HPV vaccine is now being considered for licensure by the FDA. This vaccine would protect against the types of HPV that cause most cervical cancers, but it would not protect against genital warts.
Are there other ways to prevent cervical cancer?

Regular cervical cancer screening and follow-up can prevent most cases of cervical cancer. The Pap test can detect cell changes in the cervix before they turn into cancer. Pap tests can also detect most, but not all, cervical cancers at an early, treatable stage. Most women diagnosed with cervical cancer in the U.S. have either never had a Pap test, or have not had a Pap test in the last 5 years. The HPV test can tell if a woman has HPV on her cervix. This test can be used with the Pap test to help your doctor determine next steps in cervical cancer screening.
Are there other ways to prevent HPV?

The only sure way to prevent HPV is to abstain from all sexual activity. For those who are sexually active, condoms may lower the chances of getting HPV, if used all the time and the right way. Condoms may also lower the risk of developing HPV-related diseases (genital warts and cervical cancer). But HPV can infect areas that are not covered by a condom—so condoms may not fully protect against HPV.

Sexually active adults can also lower their risk of HPV by being in a mutually faithful relationship with someone who has had no or few sex partners, or by limiting their number of sex partners. The fewer partners a person has had – the less likely he or she is to have HPV. But even persons with only one lifetime sex partner can get HPV, if their partner has had previous partners.
Sources

Food and Drug Administration (FDA). FDA News: FDA Licenses New Vaccine for Prevention of Cervical Cancer and Other Diseases in Females Caused by Human Papillomavirus.

The FUTURE II Study Group. Prophylactic efficacy of a quadrivalent human papillomavirus (HPV) vaccine in women with virological evidence of HPV infection. J Infect Dis. 2007; 196:1438-1446.

FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007; 356(19):1915-27.

Garland SM, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S, et al. Females United to Unilaterally Reduce Endo/Ectocervical Disease (FUTURE) I Investigators. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med. 2007; 356(19):1928-43.

Harper DM, Franco EL, Wheeler C, et al; HPV Vaccine Study Group. Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised controlled trial. Lancet. 2006; 367(9518): 1247-1255.

Ho GY, Bierman R, Beardsley L, et al. Natural history of cervicovaginal papillomavirus infection as measured by repeated DNA testing in adolescent and young women. N Engl J Med. 1998; 338(7):423-428.

Koutsky LA. Epidemiology of genital human papillomavirus infection. Am J Med. 1997; 102(5A):3-8.

National Institutes of Health (NIH). NIH Consensus Statement: Cervical Cancer. 1996; 14:1-38.

Paavonen J, Jenkins D, Bosch FX, Naud P, Salmeron J, Wheeler CM et al. Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. Lancet 2007;370(9596):1414.

United States Cancer Statistics, National Program of Cancer Registries (NPCR). U.S. Cancers by Type.

Weinstock H, Berman S, Cates W, Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004; 36(1):6-10.

Winer R, Hughes JP, Feng Q, et al. Consistent condom use from time of first vaginal intercourse and the risk of genital human papillomavirus infection in young women. N Engl J Med. 2006;354:2645–2654.

How to Get the HPV Test

Women Under Age 30 Women Over Age 30

I was persistent and kept repeating that I wanted
the HPV test for "extra peace of mind."

Read Frances Masterman's story
So, you've decided that you want to take every step possible to make sure you do not get cervical cancer.

Most doctors will honor your wishes on issues such as this. If not, remember that you are the one who is ultimately responsible for your health. You need to decide how important it is to have a healthcare provider who partners with you.

Here are some tips to ensure you get the HPV test:

* Arm yourself with the facts about cervical cancer, HPV and the HPV test. Read the information in this Web site thoroughly. Doctors' offices are very tight on time these days, and they will be more receptive to your requests if they can tell you have "done your homework."
* Call your doctor's or nurse's office before your next exam to find out if the HPV test is offered as part of routine screening for cervical cancer, along with the Pap. Remember: Make sure the office understands that you want the HPV test no matter what the Pap shows. Some doctors and nurses only order an HPV test when your Pap results are inconclusive (called an "ASC-US" Pap).
* If your doctor or nurse says the office does not order HPV testing for all of its female patients who are 30 and older, indicate you'd like them to make an exception for you.
* If your doctor or nurse (or the office staff) responds by saying he/she doesn't think routine HPV testing is necessary, the simplest way to respond is to say that you would still like to have the test "for my extra peace of mind."
* Follow up on test results. Keep calling until you receive an answer regarding your test results.


Do you need to ask your doctor or nurse for the HPV test?

It's a good idea to ask your doctor or nurse for the HPV test. That's because some healthcare providers do not yet order the HPV test as part of routine cervical cancer screening, or offer it only if you ask for it. However, most laboratories can do the HPV test if your doctor or nurse requests it.
Why your doctor or nurse might not automatically order the HPV test for you – and what you should do about it …

*

Unaware of approval of HPV test for routine screening.
*

Thinks the Pap is good enough.
*

Concerned the test will unnecessarily alarm you.
*

Afraid you won't return for your annual visit if HPV testing shows you don't need yearly cervical cancer screening.
*

Believes HPV testing might result in the need for unnecessary further procedures.

Some doctors and nurses are not aware that the U.S. Food and Drug Administration (FDA) has approved the HPV test for use along with the Pap for routine screening of women age 30 years and older. Some still believe that the HPV test should only be given to women if their Pap test results are unclear (called an "ASC-US" Pap). Still others simply aren't familiar with the data supporting the value of the HPV test for routine screening. Medical practice takes a while to change.

Share with your doctor or nurse the recent publication on HPV and HPV testing issued by the American Association of Reproductive Health Professionals.

Other healthcare professionals may actually recommend against routine HPV testing because they believe that although the Pap may not be perfect, it is good enough.

Respond that you know the Pap test catches many women with pre-cancerous cells, but that you would feel even more confident if you took an additional step and got the HPV test. You may want to refer your doctor or nurse to the April 2006 issue of the International Journal of Cancer ("Overview of the European and North American studies on HPV testing in primary cervical cancer screening"). This analysis of 11 studies involving more than 60,000 women documented that the HPV test is a more sensitive tool for cervical cancer screening than the Pap alone.

Your healthcare provider may worry that you will be unnecessarily anxious or alarmed if you find out you have a high-risk (potentially cancer–causing) type of the virus. After all, most women fight off the infection before it causes any problems.

Assure your doctor or nurse that you have researched the subject, and that you see the HPV test as a way to increase your peace of mind. Your healthcare provider will be more likely to feel comfortable ordering the test for you if he or she knows you already are educated on the virus and HPV testing. Show him or her the brochure (PDF) on HPV testing, available on this Web site, as evidence that you have educated yourself and know what to expect.

Some doctors and nurses fear that once women learn they do not have HPV, and thus only need another HPV and Pap test every three years, they will not come back for an annual office visit.

Communicate to your doctor or nurse that you understand the need for regular health checks – such as a breast exam – regardless of your HPV status. You can demonstrate this commitment by scheduling your next visit well in advance.

Some healthcare providers may believe the HPV test could result in the need for other, unnecessary procedures (such as a biopsy to remove cervical tissue for analysis).

Respond that you'd rather take the chance of having an extra exam that turns out to be normal, than to risk doing nothing until cervical cancer develops. You also might want to refer your doctor or nurse to an article in the October 2007 issue of the American Journal of Obstetrics & Gynecology titled "Consensus Guidelines for the Management of Women with Abnormal Cervical Cancer Screening Tests." One of the topics covered is how to manage the care of women who have HPV, but whose Pap results are normal or inconclusive. A short summary of these and other guidelines can be found in this brochure (PDF) on HPV testing. Following these guidelines should help assure that women with HPV do not have any more follow-up tests than when the Pap alone is used. Tell your doctor or nurse that you would like to get the HPV test for "extra peace of mind."

HPV testing in combination with liquid-based cytology in primary cervical screening

Prof Henry C Kitchener MD a Corresponding AuthorEmail Address, Maribel Almonte PhD c, Claire Thomson BSc a, Paula Wheeler MRes a, Alexandra Sargent PhD a, Boyka Stoykova MD d, Clare Gilham MSc e f, Helene Baysson PhD e, Christopher Roberts PhD b, Robin Dowie PhD d, Mina Desai MBchB g, Jean Mather MIBMS g, Andrew Bailey FIBMS h, Andrew Turner MB ChB h, Sue Moss PhD f, Prof Julian Peto DSc e f


Background
Testing for human papillomavirus (HPV) DNA is reportedly more sensitive than cytology for the detection of high-grade cervical intraepithelial neoplasia (CIN). The effectiveness of HPV testing in primary cervical screening was assessed in the ARTISTIC trial, which was done over two screening rounds approximately 3 years apart (2001—03 and 2004—07) by comparing liquid-based cytology (LBC) combined with HPV testing against LBC alone.

Methods
Women aged 20—64 years who were undergoing routine screening as part of the English National Health Service Cervical Screening Programme in Greater Manchester were randomly assigned (between July, 2001, and September, 2003) in a ratio of 3:1 to either combined LBC and HPV testing in which the results were revealed and acted on, or to combined LBC and HPV testing where the HPV result was concealed from the patient and investigator. The primary outcome was the detection rate of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in the second screening round, analysed by intention to treat. This trial is registered with the International Standard Randomised Controlled Trial Number ISRCTN25417821.

Findings
There were 24 510 eligible women at entry (18 386 in the revealed group, 6124 in the concealed group). In the first round of screening 233 women (1·27%) in the revealed group had CIN3+, compared with 80 (1·31%) women in the concealed group (odds ratio [OR] 0·97, 95% CI 0·75—1·25; p>0·2). There was an unexpectedly large drop in the proportion of women with CIN3+ between the first and second rounds of screening in both groups, at 0·25% (29 of 11 676) in the revealed group and 0·47% (18 of 3866 women) in the concealed group (OR 0·53, 95% CI 0·30—0·96; p=0·042). For both rounds combined, the proportion of women with CIN3+ were 1·51% (revealed) and 1·77% (concealed) (OR 0·85, 95% CI 0·67—1·08; p>0·2).

Interpretation
LBC combined with HPV testing resulted in a significantly lower detection rate of CIN3+ in the second round of screening compared with LBC screening alone, but the effect was small. Over the two screening rounds combined, co-testing did not detect a higher rate of CIN3+ or CIN2+ than LBC alone. Potential changes in screening methodology should be assessed over at least two screening rounds.

Funding
National Institute of Health Research Health Technology Assessment Programme.

Hybrid Capture 2 Technology

Hybrid Capture 2 (hc2) technology serves as the platform for QIAGEN’s nucleic acid hybridization assay for detection of human papillomavirus (HPV), Chlamydia trachomatis (CT), and Neisseria gonorrhoea (GC). This diagnostic method allows rapid, standardized testing of genetic material of the infectious agents in virtually any laboratory setting. It employs specific RNA probes, hybridization, antibody capture, and signal amplification that utilizes qualitative chemiluminescent detection.


The digene HPV Test, using Hybrid Capture 2 technology, provides an accurate, cost-effective, user-friendly method by achieving reliable detection without the need for dedicated and isolated lab space, sophisticated laboratory expertise, or concern related to inhibition and contamination.
Benefits of Hybrid Capture:

* Same-day, objective results using a micro-plate test format
* High-throughput automation for handling increasing test volumes
* Minimal required specimen preparation allowing samples to be processed quickly and efficiently
* Less complex workflow than target amplification methods
* Reduced risk of cross-over contamination due to signal amplification instead of target amplification
* Extensive clinical validation data available

hc2 technology superior to PCR methods for HPV DNA testing

For routine HPV diagnostics, it is essential to have a test system at hand which reports clinically relevant results and, hence, can impact clinical decision-making. In contrast to the detection of other infectious disease parameters, a high clinical sensitivity is critical for reliable HPV diagnostics. The hc2 technology fulfills this requirement better than any other method as outlined in multiple clinical validation studies.

In contrast, a high analytical sensitvity as provided by nucleic acid amplification technologies such as PCR is counterproductive for HPV diagnostics as they may detect many transient HPV infections of clinical insignificance. Cervical cancer screening methods require HPV detection correlating to disease and not to the sheer presence of the virus, since 90% of infections is cleared by itself without consequences.

hc2 technology measures sensitivity versus defined clinical endpoints (CIN 3+/SCC) and ensures reporting of positive results only when risk of disease progression exists. QIAGEN’s digene HPV Test has an excellent clinical sensitivity of up to 100% in primary adjunctive screening when combined with a Pap smear test.

* Clinically validated cut-off of 5000 copies/ml
* Proven in extensive multiple trials
* Ensures high negative predictive value

PCR screening can miss severe disease


PCR methods show a high analytical sensitivity with detection limits between 10-400 copies of HPV DNA resulting in detection of clinically irrelevant viral levels as such infections can be cleared off by immune response. Due to viral integration and loss of the targeted regions (L1, E1, E2) or mutation, PCR can miss cases of severe precancer and cancer cases.

* Risk of missing cases of cancer
* Detection of clinically irrelevant viral levels


Hybrid capture (hc2) versus PCR — analytical sensitivity and clinical sensitivity. The analytical sensitivity of hc2 has been adjusted to 5,000 copies of HPV DNA, and the analytical sensitivity of PCR methods can be <10 copies of HPV DNA.
How Hybrid Capture 2 Technology works

The Hybrid Capture 2 System is a signal-amplification assay that uses a technique combining antibody capture and chemiluminescent signal detection. The basic steps of the Hybrid Capture 2 assay are outlined below:

Basic Steps

Clinical specimens are prepared by adding a base solution, which disrupts the virus or bacteria and releases target DNA. Presence or absence of target DNA is read from the results of the chemiluminescent reaction.

Hybridize RNA probe with target DNA Hybrid Capture Signal Amplification

Fig 1: Hybridize RNA probe with target DNA. Target DNA combines with specific RNA probes, creating RNA:DNA hybrids


Fig. 2: Hybrid Capture. RNA:DNA hybrids are captured onto a solid phase coated with universal capture antibodies specific for RNA:DNA hybrids.


Fig. 3: Signal Amplification. Capture RNA:DNA hybrids are detected with multiple antibodies conjugated to alkaline phosphatase. The signal resulting from the chemiluminescent reaction is read and results interpreted.

Doctors call for cancer screens

DUBAI // Doctors have called for a national cervical cancer vaccination and screening programme to catch cases earlier and reduce the rate of the second most common cancer found in women, one that has seen progressively higher incidence in the UAE.

Cervical cancer affects 9.9 women in every 100,000, according to figures by Health Authority Abu Dhabi (HAAD), almost twice the incidence in the broader Middle East, which amounts to nearly five in every 100,000.

It afflicts women at a rate second only to breast cancer, but 70 per cent of cases are diagnosed in the late stages. At that point, only one in three women has a chance of survival. There is no co-ordinated screening programme for cervical cancer in the UAE, as there is in countries where most cases are detected in the early stages.

Dr Saad Aswad is a senior consultant gynaecologist and oncologist – the only specialist of his kind in the UAE – at Tawam Hospital in Al Ain. He compiled a detailed report on a proposed screening programme for cervical cancer drawing on the expertise of more than 40 health professionals and forwarded it to the Ministry of Health in 2004. There has still been no move to implement any of the plans. MoH officials were not available yesterday to comment.

“We need to do something to protect the women,” Dr Aswad said. “Cervical cancer is a cancer we can prevent. Why are we not doing this across the country? If the Ministry of Health introduced it, I think everyone would follow.”

While schoolgirls in Abu Dhabi are offered the Gardasil vaccination for up to Dh50 (US$13.60) for the required three doses, it can cost up to Dh1,900 in Dubai and is not as widely available in other emirates.

Dr Aswad said the preventive vaccine should be available across the whole country.

“We must push for this to be nationwide. It is much easier to implement prevention than cure.”

HAAD said in April it planned to build on a successful pilot vaccination programme in schools and make the vaccine available to all schools in the Emirates.

Last year it vaccinated around 6,000 girls aged 17 and has given another 4,000 the first dose this year. There was a 70 per cent uptake during the pilot scheme. Dr Mawahib al Biate, head of the gynaecology department at the GMC Hospital in Ajman, said a national vaccination programme was needed in the UAE.

“Prevention is always better than the cure,” she said. “A national programme would be a very good idea because of the rates here.” She also said it did not make sense for such an important vaccine to be offered cheaply to some but not others.

In 1998 the MoH reported only eight diagnosed cases of cervical cancer in the country. Last year Tawam Hospital alone saw at least 100 cases, Dr Aswad said.

Recent studies into the efficacy of Gardasil, which was approved by the US Food and Drug Administration in 2006, showed it was effective against the human papillomavirus (HPV) type 16 for an average of eight and a half years. The women in the study, by the University of Washington in the US, were vaccinated in 2001, so more follow-up tests are needed to establish the length of protection. HPV 16 and 18 cause 70 per cent of cervical cancer cases worldwide. Gardasil, made by Merck, is licensed in 109 countries, but some of them find it more difficult to implement a vaccination programme, Dr Aswad said.

Health officials estimate one in 10 women will get an HPV infection in their lifetime, but it is more common in women under 30. Some strains are sexually transmitted, and questions have been asked in some countries about the moral issue of vaccinating young girls.

“Here cervical cancer is increasing out of proportion with the population growth,” Dr Aswad said. “It is time to start protecting the women.”

Dr Ibrahim Abd Elrahman, a consultant gynaecologist and obstetrician at The City Hospital in Dubai, applauded any effort to introduce a national vaccination programme. He saw many women who had never had a Pap smear. “Often I get someone in their late 20s or early 30s who say they have never had one. I organise one with their consent.”

Mitya Underwood

* Last Updated: May 14. 2009 12:14AM UAE / May 13. 2009 8:14PM GMT

Cervical cancer strikes younger women in UAE

By Nina Muslim, Staff Reporter
Published: May 14, 2009, 10:30
http://archive.gulfnews.com/nation/Health/10313458.html

Dubai: Women in the UAE are dying at a younger age from cervical cancer, about ten years younger than the world average of 49, prompting doctors to call for better awareness and prevention.

Dr Sa'ad Gazzal Aswad, head of obstetrics and gynecology at Tawam Hospital said at a press conference on Wednesday that he was seeing more and more women between the age of 35 and 40, instead of 50 a decade ago.

"I don't know why; we will have to study more. But the point is that it affects young women of childbearing age with children, leaving (the children) when they die," he told Gulf News later.

"The impact is really sad. I had a 32-year old patient who died and she had nine children, the youngest is 2. The cancer affects not just the person but the whole family," he said.

He added the patient, like more than 70 per cent of all cases he has been receiving, was referred to him when her cancer was already considered advanced and had a lower rate of survival. According to Tawam Hospital records, about 100 cases of cervical cancer were recorded last year.

Furthermore, more women in their 20s were presenting with abnormal pap smears, or pre-cancerous lesions.

Cervical cancer is caused by strains 16 and 18 of the Human Papilloma Virus (HPV), which is the same virus (but different strain) that causes genital warts. It is transmitted through sexual contact, which does not necessarily involve sexual intercourse. There are two vaccines available to prevent the cancer, but only one is approved by the US Food and Drug Administration.

Dr Wissam Haddadin, franchise manager of the cervical cancer vaccine Gardasil, produced by Merck, Sharpe and Dohme, said more awareness and prevention were needed to stop the preventable disease from striking women down.

"Some people don't realise (in cervical cancer's case) there is a causative agent," she said.

She added prevention and awareness in the region was very low, saying a 2006 informal survey the company conducted found about 20 per cent of women questioned knew what a pap smear was and only 9 per cent did it.

Pap smear is a screening procedure, in which a cell scraping is taken from the cervix and examined for pre-cancerous lesions.

Some screening programmes are taking place, including at primary healthcare centres under the Ministry of Health. Private medical centres also offer the service. However, there is no comprehensive and uniform policy in place to ensure all women in the UAE are being screened for the cancer.

Do you have regular checkups? Do people avoid being checked for fear of having an illness? Do you know of anyone who had successfully battled cancer due to early detection?
Your comments

The article has definitely created awareness about cervical cancer. More information regarding symptoms, causes and cures would help readers understand the disease better. Also at what age must a woman get herself tested and details could help women to have regular checkups. Generally people avoid checkups either because they are very busy in their family life, they feel fit or they have a fear of having an illness. Women (especially working women) lead a hectic life and have no time for themselves. My cousin?s wife (age 37) was diagnosed with breast cancer last year. She underwent mastectomy and then chemotherapy and radiation and now is leading an almost normal life. She feels weak at times and does not have the energy she had before the illness. Cancer is a killer disease and fighting it is possible if detected in the early stages. Awareness about the disease and its various forms must be spread so that people will not hesitate to go for required tests. Regular exercise and a healthy diet could ward off most diseases. A regular checkup even if a person is perfectly fine and healthy is necessary.
Naina Nair
Sharjah,UAE
Posted: May 14, 2009, 17:23

Doctors should advise the women to do this Pap smear test and should encourage them to do it, there is no harm if the doctor will tell his patient to do this check up test, I told my wife to do a full check up and they didn't even tell her about this test.
Samer K.
Dubai,UAE
Posted: May 14, 2009, 17:20

I had been experiencing abnormalities in my menstrual cycle. When I came to Dubai, I decided to visit an OB/Gynaecologist for a check up. I found out that a year after giving birth, I must have a pap test and also that the doctor discovered some infection. And she told me that if I had taken long to seek doctor's advice, it could lead to cervical cancer. So, that is when I realised that a single infection that I didn't mind for a long time could worsen my health. So, now, I do my pap test every year to check the condition of my cervix. It is good for women to be aware and please do not be ashamed of this kind of situation. Doctors are here to understand us and to help us prevent the sickness. Always remember that Prevention is better that CURE.
Mhadzie
Dubai,UAE
Posted: May 14, 2009, 11:44

I am a mother and know how preoccupied my lot is with looking after our young children and families. Most mothers are so busy attending to the needs of the rest of the family members that they hardly have ANY time left for themselves. This lack of time for oneself often does take quite a toll on the mothers. I sincerely appreciate such eye-opening articles by Gulf News. Please continue the good work.
Shiuli Dutt Dey
Dubai,UAE
Posted: May 14, 2009, 11:43

the issue is that most of these tests are not even covered by insurance so unfortunatly people think about the financial aspect. Insurance should cover one test on a regular basis, this would also save them money when curing at an early stage instead of big expenses at a late stage.
From A Reader
Abu Dhabi,UAE
Posted: May 14, 2009, 11:00

There definitely should be more awareness about Cervical cancer, since it is becoming very common among women at a very early age.The worst thing about this cancer is that it is diagnosed at 3rd or 4th stage and it becomes too late to save the patient then. I would like to urge every woman to educate themselves by reading about cervical cancer and to take precautionary measures in advance. Also, it is important to spread the awareness about the disease among my friends and family. Being 23 years old, I would like to get preventive vaccination for the same. I would like to know about hospitals and clinics which would conduct the necessary test. I think the authorities should take measures to spread the awareness among women. Many people haven't even heard about this disease.
Zahrah
Dubai,UAE

How do I talk to my partner about HPV?

You and your partner may benefit from talking openly about HPV. You can tell your partner that:

* HPV is very common. It can infect the genital areas of both men and women. It usually has no signs or symptoms and goes away on its own.
* Most sexually active people get HPV at some time in their lives, though most will never know it. Even people with only one lifetime sex partner can get HPV, if their partner had it.
* There is no test yet for men to find out if they have HPV. But the most common health problem caused by HPV in men is genital warts. The type of HPV found on your HPV test can cause cervical cancer in women; it does not cause genital warts.
* Partners who have been together for a while tend to share HPV. This means that your partner likely has HPV already, even though your partner may have no signs or symptoms.
* Having HPV does not mean that you or your partner is having sex outside of your relationship. There is no sure way to know when you got HPV or who gave it to you. A person can have HPV for many years before it is found.

If your sex partner is female, you should talk to her about the link between HPV and cervical cancer, and encourage her to get a Pap test to screen for cervical cancer.
Common Questions about HPV
Is there a treatment for HPV or abnormal cells?

There is no treatment for HPV (a virus). But there are treatments for abnormal cervical cells, which can be killed or removed. Treating abnormal cells will stop them from growing into cancer. But it may not remove the virus (HPV). That’s why it’s important to go back to your doctor as told, to make sure abnormal cells do not grow back. You may need to get Pap tests more often for a while. But most people do eventually fight the virus off.
Does having HPV or abnormal cervical cells affect my chances of getting pregnant or having healthy babies?

Having HPV or cell changes on your cervix does not make it harder to get or stay pregnant. The type of HPV that is linked to cancer should not affect the health of your future babies. But if you need treatment for your cell changes, the treatment could affect your chance of having babies, in rare cases. If you need treatment, ask your doctor if the treatment can affect your ability to get pregnant or have a normal delivery.
couple Will I pass HPV to my current partner?

If you have been with your partner for a while, your partner likely has HPV too. But your partner likely has no signs or symptoms of HPV. Partners usually share HPV, until your bodies fight it off naturally. There is no way to know if your partner gave you HPV, or if you gave HPV to your partner.
Can I prevent passing HPV to a new partner?

Condoms may lower your chances of passing HPV to your new partner, if used all the time and the right way. But HPV can infect areas that are not covered by a condom—so condoms may not fully protect against HPV. The only sure way to prevent passing HPV to a new partner is to not have sex.