Extra Caution with HPV Tests

There is a difference between caution and overdiagnosis. It is the difference between healthy fear and near-pathological paranoia. And medical practitioners have the responsibility to ensure that before they write on their Rx pads to order the test, they have well-informed clinical bases for doing so.

DURING March this year, the United States Preventive Services Task Force (USPSTF) rang the bell of caution with regard to the now-popular early detection test for cervical cancer called human papillomavirus (HPV) testing.

Six studies agreed that it has a higher sensitivity to cancer indicators but lower specificity to cervical cancer compared to tissue studies. This means that it gives more positive results than it correctly should. And that’s where the concern of women patients lies.

Studies have shown that such bloated counts of positive results in the past led to repeated testing and invasive procedures, such as colposcopy (using a lighted magnifying device) and cervical biopsy (removal of a small tissue in the cervix for microscopic studies). These procedures have resulted to vaginal bleeding, pain, infection and failure to diagnose due to inadequate sampling. Some treatments for lesions that are not yet cancerous (e.g. cold-knife cone-tissue biopsy, loop excision) are associated with serious pregnancy consequences, such as preterm delivery.

There is convincing evidence that many of these precancerous lesions eventually regress and disappear, or simply grow so slowly that they fail to become serious within the lifetime of the person. Thus treatments of these conditions are technically “overdiagnosis.” It confers no benefit and leads to unnecessary surveillance, diagnostic tests and treatments with the associated harms, the task force said.

That’s for the physical harm. For the psychological harm, these include short-term increases in anxiety, distress and concern about health.

Adequate evidence exists that women 65 years old and younger have more false positive HPV screening results. Those age 65 and older had only a small risk of it. The rates are also higher among women younger than 30 to 35 than women in an older age group.

Their recommendation? [READ MORE]

This article appears in SunStar Cebu newspaper on 25 July 2012.

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