Re: GYN: HPV Testing
From: Dr. Myer Bornstein (mbornstein@mortonhospital.org)
Mon Mar 27 06:14:34 2000
In answer to cost containment, with colopscopy and biopsies the cost ranges
from $300 -$1200 depending on the number of biopsies. Our charge is
minimal, but the path charge for each of the biopsy can range up to $250
apiece. Therefore a pap that shows ASCUS with a negative Hybrid test save
$. Ralph Richards showed that a double negative pap and test that the
chance of CIN was , 99.9%
Myer
--
Myer S. Bornstein, MD, CPE, FACOG
>----- Original Message -----
From: "Joanne Bulley, MD" <jbulley@cheshire.net>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@forum.obgyn.net>
Sent: Monday, March 27, 2000 7:17 AM
Subject: Re: GYN: HPV Testing
> But in this day of cost concious medical care - is this the right way to
> triage? I would like to have something like Aldara available - rather
> than resorting to 5FU. IF ther becomes something we CAN do (that works)
> for the HPV, then I would consider typing it out! Otherwise it is still
> good medicine and likely costs less to do that 6 month repeat Pap to see
> who has resolved and who still has ASCUS or SIL.
>
> At Sun, 26 Mar 2000, Myer S. Bornstein, MD, CPE, FACOG wrote:
> >
> >I went to a meeting this weekend on Innovations in the Diagnosis and
> >treatment of HPV, (slightly biased put on by 3M and Digene)
> >
> > However, the message made sense. One HPV and its continuance is
probably
> >immunity related and that people in some impairment of their immune
response
> >become chronic HPV carriers and have more of a chance of progressing to
CIN
> >and Cervical CA. They are now in trial with Aldora intra-vaginally to
see
> >if it can release cytokines and interferon to resolve the virus and the
CIN.
> >
> >The algorithm for HPV testing for the triage of ACSUS test results is:
ASCUS
> >Pap test results do HPV test, if negative for High-Risk types return to
> >routine screening, if positive colposcopy and treatment if indicated.
> >However, those people need to be followed very closely since they will
> >develop HGSIL within 3-5 years.
> >
> >Myer
>
> So - is your "follow very closely" doing Paps every 6 months? If so -
> what have you gained by doing the HPV screen? You would (I assume) do
> the following - ASCUS - repeat 6 months - if ASCUS or SIL - colpo. If
> not ASCUS return in 6-12 months (to coincide with her needed medical
> care) - and she would not be lost to follow up. I use any abnormal Pap
> to re-educate that women need to never NOT go for their "annuals"... So
> not a lot is gained by knowing the HPV type - until we do have a
> treatment to offer to reduce the viral load.... or some such!
>
> --
> Joanne Bulley, MD
> Keene, NH, USA
>
