Re: The Home Pap Test
From: art fougner, md (evsono@pipeline.com)
Thu Jan 6 11:39:12 2000
Don't ASC US!
art
At Wed, 5 Jan 2000, J. Hellriegel wrote:
>
>Last night a Buffalo TV station ran a special on “do it yourself” pap
>tests. I have already had patients asks me about it. My search turned
>up the following.
>
>What do you think about self-assessment for cervical neoplasia?
>
>--
>J. Hellriegel
>------------------------------------------
>
>------------------------------------------
>The Lancet, Volume 354(9194), 4 December 1999. p 1970
>------------------------------------------
>
>Screening for cervical neoplasia by self-assessment for human
>papillomavirus DNA
>
>Hillemanns, Peter; Kimmig, Rainer; Huttemann, Ulrike; Dannecker,
>Christian; Thaler, Christian J
>
>Department of Obstetrics and Gynaecology, Klinikum Grosshadern,
>Ludwig-Maximilian-University, 81377 Munich, Germany (P Hillemanns MD, R
>Kimmig MD, U Huttemann, C J Thaler MD)
>
>Correspondence to: Dr Peter Hillemanns (e-mail:
>Peter.Hillemanns@t-online.de)
>
>We evaluated self-collected vaginal human papillomavirus tests for
>cervical cancer screening and compared it with the specimens taken
>directly from the cervix in 247 patients at high-risk for cervical
>disease. The sample taken by the patient showed human papillomavirus
>DNA in a higher percentage than the sample taken by a doctor.
>Sensitivity of high-risk human papillomavirus types for high-grade
>cervical precursors (CIN 2/3) and invasive cervical cancers were 93% for
>both methods.
>
>Screening for cervical cancer based on cervical cytology has led to a
>significant decrease in incidence and mortality. However, there are
>problems with compliance and limited sensitivity of cytological
>screening. Epidemiological studies have shown a strong association of
>anogenital human papillomavirus (HPV) with cervical cancer; the
>prevalence of HPV in cervical cancer may be close to 100%.1 Testing for
>HPV has been recommended for screening or as an adjunct to cytology.2
>
>We prospectively evaluated the sensitivity of self-collected HPV tests
>and compared it with the detection rate of specimens directly taken from
>the cervix in 247 patients attending our colposcopy clinic. Each woman
>was asked to introduce a cytobrush about 5 cm into the vagina and place
>it into the specimen collection tube. During the following
>gynaecological examination two smears were obtained from the ecto- and
>endocervix and an additional cytobrush was taken for HPV analysis. HPV
>DNA testing was with a commercial signal-amplifying capture molecular
>hybridisation assay that detects DNA of low-risk HPV types 6, 11, 42,
>43, 44 and high-risk types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58,
>59, 68 (Hybrid Capture System II, Digene, MD, USA). Colposcopy was done
>and directed biopsies and/or endocervical curettage were taken when
>indicated.
>
>94% of patients favoured self-sampling as compared with sampling by a
>physician. HPV positivity was present in 53% of the patients' brushes
>compared with 42% of the specimens collected by a doctor (p< 0.01)
>(figure). High-risk HPV types were significantly more often found in
>the self-taken samples (47%) than in the clinicians' samples (38%;
>p<0.05). Biopsy-proven CIN 1-3 was diagnosed in 56 (23%) women, 38
>(15%) of whom had high-grade CIN 2/3. Two patients had invasive
>cervical cancer. The sensitivity of self-taken samples for high-risk
>HPV types CIN 1-3 was 86% compared with 80% for the doctors samples. For
>CIN 2/3 sensitivities of high-risk HPV were 92% for both methods. The
>two cases with invasive cervical cancer were high-risk HPV positive with
>both collection methods. High-risk HPV DNA test results were concordant
>in 83% of the women; 85 (34%) were positive and 121 (49%) were negative
>on both tests. In nine (4%) women the self-taken samples were negative
>and doctors' samples positive. 32 (13%) women had a positive HPV
>self-sample and a negative doctors' sample. Three (8%) CIN 2/3 lesions
>would have been missed by both sampling methods.
>
>These results indicate that self-sampling is a reliable method of
>testing for HPV and, more important, for cervical cancer screening with
>a sensitivity of 93% for high-grade HPV and invasive cervical cancer.
>Women who do not participate in existing screening programmes may be
>offered this method. In developing countries, self-assessment can be
>advised as primary screening for cervical cancer every 3 to 5 years
>followed by colposcopically directed cervical biopsy and treatment
>because cytology may not be readily available. Taking into account that
>screening cytology has a sensitivity of less than 80% and a negative
>predictive value of 99.8%,3 screening by self-assessment for HPV DNA may
>be an option even for countries with a cytology screening programme
>because of improved sensitivity and similar negative predictive value
>(97.4%) especially if the results reported here are reproduced in larger
>studies.
>
>1 Bosch FX, Manox MM, Munoz N, et al. Prevalence of human
>papillomavirus in cervical cancer: worldwide perspective. International
>biological study on cervical cancer (IBSCC) Study Group.
>
>2 Cuzick J, Szarewski A, Terry G, et al. Human papillomavirus testing
>in primary cervical screening.
>
>3 Soost HJ, Lange HJ, Lehmacher W, Ruffing-Kullmann B. The validation
>of cervical cytology. Sensitivity, specificity and predictive values.
>
>--
>John Hellriegel
>
--
art fougner, md
what the heck happened to my sig file??
