1. HPV and Cervical Cancer Screening and Prevention

2. Screening Options Traditional Pap Test Liquid-Based Pap Test HPV DNA Test

3. Traditional Pap Test For a Pap test, a medical practitioner scrapes a sample of cells from the cervix. The cervical cells are smeared on a glass slide and examined under a microscope. Medical personnel look for abnormalities in the cervical cells that could progress to cancer.

4. Liquid-Based Pap Test In liquid-based cytology cervical cells are placed in liquid in a small bottle. Some of the liquid is placed on a slide and then examined under a microscope for abnormalities. Research has shown liquid-based Pap tests to be more accurate than the conventional method because blood and mucous are removed, making the cells easier to see. Liquid-based Pap tests are more expensive and may not be available at all clinics.

5. The HPV DNA Test The HPV DNA test checks directly for high-risk HPV. HPV testing is FDA-approved in conjunction with a Pap test for women age 30 and older and for women of all ages as a follow-up to inconclusive Pap test results. For women over 30, an HPV test in conjunction with a Pap test is more accurate than the Pap test alone at identifying women with cervical cancer or its early signs. Women under 30 should not get the HPV test with the Pap test unless they receive abnormal Pap test results. Young women have more frequent HPV infections, which usually clear without medical action.

6. Screening Guidelines Begin cervical cancer screening 3 years after the initiation of sexual intercourse, or by age 21 (whichever comes first). Women should be screened annually with a regular Pap test or every 1-2 years with a liquid-based Pap test. All women under 30 should be screened for cervical cancer at least every two years. Women age 30 and older with 3 normal Pap tests in a row should discuss the recommended frequency of cervical cancer screening with their doctor. Women who had a hysterectomy may still need to be screened regularly, depending on the type of hysterectomy they had. They should discuss their situation with their doctor.

7. HPV Test Results and Guidelines For women age 30 and older:  If both the Pap and HPV tests are negative (normal): Get tested again in 3 years.  If the Pap test is negative and the HPV test is positive: Repeat the Pap test and HPV test in 6 to 12 months to see if the virus has cleared. If the virus is still present, talk to your doctor about the next steps.  Both tests are positive: Talk with your doctor about what to do next.

8. Prevention – HPV Vaccine In June 2006, the FDA approved the Gardasil vaccine for protection against HPV types 16 and 18, which cause 70 percent of cervical cancers, and types 6 and 11, which are responsible for 90 percent of genital warts. A second HPV vaccine, Cervarix, is completing clinical trials. The release of trial results is expected in 2009. This vaccine protects against types 16 and 18. The availability of an HPV vaccine marks a tremendous milestone in the effort to prevent and ultimately eliminate, cervical cancer.

9. Who should receive HPV vaccines? To maximize effectiveness, an HPV vaccine should be administered before a person becomes sexually active. The FDA approved Gardasil for girls and women aged 9-26. The Federal Advisory Committee on Immunization Practices (ACIP) recommends that Gardasil be given routinely to females aged 11 to 12. However, the vaccine can be administered to girls as young as 9 and to women aged 13 to 26 who have not already received the HPV vaccine. Research on vaccinating women over 26 and men is underway; look for the results in the coming months!

10. Are the vaccines safe? In June 2007, WHO’s Global Advisory Committee on Vaccine Safety (GACVS) concluded that both vaccines had good safety profiles. Redness and tenderness at the vaccination site, along with low-grade fevers are the most common side effects for both vaccines. WHO recommends observation for 15 minutes following Gardasil vaccination due to reports of dizziness and fainting. The vaccines are not recommended for women who are pregnant.

11. With the HPV vaccine, is screening still necessary? Yes! HPV vaccines should be part of a comprehensive strategy to eliminate cervical cancer. Screening will still be needed to target cervical cancers caused by HPV types not covered by the vaccine and for women who have already been exposed to HPV types 16 and 18. In regions where cervical cancer screening is not possible, vaccination is the best way to protect the next generation of women from cervical cancer.