Q&A: HPV Testing

M. D. Anderson Cancer Center
Date: January 2010
Duration: 5:30

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The following is a presentation from the University of Texas, M.D. Anderson Cancer Center.

Doctor Helen Rhodes, Associate Professor in M.D. Anderson's Department of Gynecologic Oncology, answers the most common questions about HPV testing.

Dr. Rhodes:
HPV stands for Human Papillomavirus. It's actually a group of viruses. There's 100 of them that can infect humans, and they're numbered 1 to 100. Of those 100, 40 can infect the genital tract. And of those 40, 13 are high-risk HPV types, and the rest are intermediate- or low-risk types. And it's the high-risk HPV types that we're most concerned with.

It is the most common sexually transmitted infection. It's estimated that 80 to 90% of women will be HPV positive at some point during their life.

There is a known link between infection with one or more of the high-risk HPV types, and the development of cervical cancer, vaginal cancer, vulvar cancer, and pre-cancer or dysplasia of the vagina, vulva, and cervix.

The FDA has approved high-risk HPV testing for women over 30. And that's offered, should be offered at the time of her PAP test, when she sees her gynecologist or family physician each year.

In women under 30 it's not FDA approved. Therefore it may not be paid for by insurance. And clinically so many women under the age of 30 have transient infections with HPV that they're cleared in the majority of cases. The body can actually clear the infection before it causes significant changes to the cervix.

I think the confusing thing to patients is that HPV infection is not what we treat. What we treat as clinicians is the effect of the viral infection on the body. And what can happen is, a woman infected with high-risk HPV or low-risk HPV can develop genital warts, pre-cancer, which is called dysplasia, or cancer, and that's what we treat. We treat the abnormal cell that can result as a result of HPV infection. But we don't treat the infection.

We used to think that once you were positive for HPV, you would be positive for HPV the rest of your life. But now we know that that's not true. And that's why we don't do routine HPV testing. Or that's one of the reasons we don't do routine HPV testing in younger women, because with a healthy immune system you can clear the virus. So no, you're not positive for life.

If a woman's PAP test and her high-risk HPV test are both negative, and she's in a monogamous sexual relationship, then she does not need to have a PAP smear or PAP test every year. She can increase the interval of her screening to 2 to 3 years. But she still needs to see her doctor every year for an annual physical and pelvic exam.

If your PAP test is normal, but your high-risk HPV test is positive, do not panic. Nothing further needs to be done. What's recommended is that you have another PAP test and high-risk HPV test in 6 to 12 months time.

If your PAP test is abnormal, and your high-risk HPV test is positive, we recommend colposcopy, which is a further evaluation of the cervix under a microscope.

If your PAP test is abnormal and your high risk HPV test is negative, we still recommend colposcopy, because remember we are treating the abnormal cells on the cervix that HPV can cause. We're not treating the HPV infection.

I think the hardest thing for a newly diagnosed HPV woman to deal with is: How did she get it? Who gave it to her? How long has it been there? And why didn't I know about this before? And it's hard to know how long a woman has been infected with HPV. And I encourage women to talk to their partners, be open and honest with them. Because there's a lot of implications about being diagnosed with a sexually transmitted infection that may have been present for years and not tested for. So it may have been a previous partner that infected her, or her partner's previous partner may have infected him, and he didn't know he had it. Because men, in general, do not know they have HPV. They don't have symptoms.

For more information about HPV testing and cervical cancer screening, visit the Focused on Health website at www.MDAnderson.Org/focused.

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