Long term duration of protective effect for HPV negative women: follow-up of primary HPV screening randomised controlled trial
BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g130 (Published 16 January 2014) Cite this as: BMJ 2014;348:g130
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This interesting article fails to raise the issue of the ethics of HPV testing, which are going to become a more contentious issue as more women are screened for HPV.
We encourage all patients diagnosed with a sexually transmitted infection to tell their previous sexual partners. If a transmission risk remains, we encourage them to tell their future partners. In the case of potentially life-threatening infections like HIV, it is mandatory for patients to inform their partners: if the patient refuses to do so, the doctor may break confidentiality to inform the at-risk partner (1). Knowingly and deliberately exposing someone to HIV infection is a crime in the UK (2).
HPV infection is very common – most sexually active adults will be infected with at least one strain at some point: 39% of UK 20-24 year old females have potentially oncogenic HPV 16 or 18 (3).
With the exception of strains which cause genital warts, most HPV infections are initially asymptomatic: currently most HPV-infected women are blissfully ignorant of their status. If widespread HPV testing is rolled out, how will we advise women to talk to their sexual partners about their HPV status? Sexually transmitted infections are still a stigmatising and difficult topic for people to discuss: especially if the infection is untreatable.
Will we advise women to tell their partners that they are infected with an untreatable infection? Will we advise them that they need to tell their partners only about oncogenic strains and strains which cause warts? There are might be legal ramifications for a woman who knowingly transmits HPV to a male partner, who subsequently infects another female, who develops cervical cancer.
A huge public health campaign will be needed, to de-stigmatise HPV infection by making people aware of its prevalence. We need to arm patients with the facts, so that they can have a meaningful conversation about HPV with their partners.
If we are going to tell women their HPV status, we should support their ability to cope with that information.
1. GMC Statement HIV Infection and AIDS 1993
2. http://news.bbc.co.uk/1/hi/5094708.stm
3. https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...
Competing interests: No competing interests
Dear Editors,
This excellent research article definitively demonstrates that there exists no need to use expensive HPV DNA tests in screening women for cervical cancers or precancerous lesions, since cytology detects the same CIN3 lesions!
In younger women, visual inspection methods are even faster, cheaper, equivalently specific and more sensitive than Pap smear tests for detecting cervical lesions and cervical cancer.
They should be widely used as screening methods, replacing cytology.
References
http://www.ncbi.nlm.nih.gov/pubmed/23248422
http://www.ncbi.nlm.nih.gov/pubmed/22960894
http://www.ncbi.nlm.nih.gov/pubmed/22771589
http://www.ncbi.nlm.nih.gov/pubmed/22726999
http://www.ncbi.nlm.nih.gov/pubmed/22276847
http://www.ncbi.nlm.nih.gov/pubmed/22269409
http://www.ncbi.nlm.nih.gov/pubmed/22262492
http://www.ncbi.nlm.nih.gov/pubmed/21387289
http://www.ncbi.nlm.nih.gov/pubmed/20865420
http://www.figo.org/journal/acceptability-cervical-cancer-screening-visu...
http://www.ijstr.org/final-print/july2012/Assessing-Alternate-Technique-...(VIA)-For-Screening-Of-Carcinoma-Of-Cervix-In-Situ-For-Low-Resource-Countries-Like-India.pdf
http://www.bmj.com/sites/default/files/response_attachments/2013/06/VIA.pdf
http://www.bmj.com/sites/default/files/response_attachments/2013/06/Colp...
Competing interests: No competing interests
Some facts about HPV (1):
-HPV can cause serious health problems, including genital warts and certain cancers.
-There is no certain way to tell who will develop health problems from HPV and who will not.
-In most cases HPV goes away by itself before it causes any health problems, and most people who become infected with HPV do not even know they have it.
-Anyone who is having (or has ever had) sex can get HPV. HPV is so common that nearly all sexually-active men and women get it at some point in their lives. This is true even for people who only have sex with one person in their lifetime.
Let me explain why I want to bring above points into your notice. The research (2) says that HPV negative result calls for a next screening after 5 years whereas with cytology it is only 3 years period. The biological explanation may be that HPV negative smears means a better immune status of the subject and hence delay in next screening required or there is an incubation period from HPV positivity to development of CIN. In any case, oncogenic HPV demonstration should be followed by an antiviral treatment (which is not avilable thus far) followed by vaccine administration should be health strategy.
References:
Competing interests: No competing interests
Re: Long term duration of protective effect for HPV negative women: follow-up of primary HPV screening randomised controlled trial
HPV testing can have important social and psychological effects on women and can potentially damage their wellbeing, particularly when used outside an organized prevention program.
This article confirms that HPV testing has similar sensitivity but more overdiagnosis than the Pap test. Primary screening with HPV testing in European countries should be reconsidered. Resources saved in molecular testing may well be addressed in implementing vaccination strategies that are still underused.
Competing interests: No competing interests