We have the power to protect cervical health

Cervical cancer is one of the most common cancers in women worldwide. It starts in the cervix, located at the lower part of the uterus. When detected early, or in the pre-cancer stage, treatment can be highly successful. Persistent infection of certain high-risk types of HPV (the Human Papillomavirus) are known to be the primary cause of cervical cancer.

The HPV test checks for high-risk HPV infection, with a test which is very accurate. However, the simple detection of high-risk HPV is not enough to cause concern, because HPV is very common and most infections resolve on their own and become undetectable. Clinically validated HPV tests are designed to detect infections that may potentially lead to precancerous changes of the cervix, and if left untreated, could progress into cervical cancer. Because modern HPV tests are automated, a trained specialist is not needed to visually search for abnormal cells, thereby reducing human error. A negative HPV test is greater reassurance that cervical cancer is not developing.

A colposcopy is an important step toward prevention after receiving abnormal test results. During a colposcopy procedure, a healthcare provider uses a colposcope (a lighted magnifying device) to look for problems in the cervix that might be missed by the naked eye.

During colposcopy, the healthcare provider may decide to take a closer look at the cells on the cervix by taking a biopsy or small tissue sample. The biopsy is sent to a laboratory to determine if there are cell changes indicating cervical pre-cancer or cancer. After the procedure, there may be some soreness and vaginal bleeding or discharge.

Biomarkers provide biologic information that can help healthcare professionals understand what is happening in the body at a molecular level and could help them identify if something is wrong. Hear Danielle explain why biomarker technology is an important development in cervical cancer prevention.

Biomarkers help us understand if there are signs an HPV infection is transforming, and could potentially develop into cancer if allowed to progress. In March 2020, the U.S. FDA approved for the first time a biomarker-based test, giving women with positive high-risk HPV screening results a new option to get additional information, sooner.

This next generation cervical screening technology detects the simultaneous presence within a single cell of the two biomarkers -- p16 and Ki-67. When found together, this is an abnormality associated with an HPV infection that shows signs of transformation towards pre-cancer or cancer. A positive "dual-stain" result does not mean a woman already has, or will definitely develop cervical cancer, but it indicates she is more significantly at risk for disease. The use of this type of biomarker test helps guide clinicians in making patient care decisions, and helps distinguish who may benefit most from immediate referral to colposcopy versus who can wait for later, repeat testing.

The Pap test (sometimes called the Pap smear test) looks for changes in cells before they develop into cancer. The HPV test looks for the presence of high-risk HPV which is known to cause about 99% of all cervical cancers. Hence, the HPV test can be a better predictor of risk for cervical disease.

To perform a Pap test, healthcare providers use an instrument, called a speculum, to help open the vagina, so that the cervix can be viewed. Another device is then inserted to collect a sample of cells from the cervix. The samples are then either placed on a glass slide or placed in a collection vial containing preservative fluid, which are then sent to a laboratory. At the laboratory, a technician or pathologist will prepare the sample for viewing under a microscope, to see if there are signs of abnormal cells. 

Sample collection for cervical screening may feel a bit uncomfortable, and some women may experience some slight pain or pressure when the speculum is inserted or when the sample is taken from the cervix.

In the medical world, "triage" refers to the process of sorting people based on whether a patient may benefit from an immediate intervention or can be allowed more time before follow-up or retesting. In the case of cervical cancer screening, it may be recommended that women who receive a positive high-risk HPV and/or abnormal Pap result get managed more closely, with follow-up care or testing.

Scientific advancements have enabled new options for triage of positive or abnormal cervical cancer screening results, using biomarker technology. The first such test approved by the FDA in early 2020 is based on use of two biomarkers, p16 and Ki-67. When these two biomarkers are both found simultaneously within the same cell, it indicates that an HPV infection is causing cellular changes that may progress over time in cervical precancer or cancer. This abnormality means a patient could be at increased risk for cervical disease, as an HPV infection could progress to cervical pre-cancer or cancer if left untreated.  

The biomarker triage test can be run from the same sample collected for a Pap or HPV test, and is performed in the laboratory using a special two stain process. The sample is analyzed under the microscope by a cytopathologist or technician. Biomarker test results can help guide clinician decisions about next step patient care.

You and your healthcare provider should discuss what is right for you and how often you should be screened. Medical guidelines offer different ways that the HPV and Pap tests can be used depending on a number of factors such as the patient’s age and medical history. What is important to know is if you have already been tested for HPV, and when you should attend your regular screening exams.