High Risk HPV DNA : Relevance of cossetting for HC-II , co testing for HR-HPV along with Thin prep or pap tets.

High Risk HPV DNA : Relevance of cossetting for HC-II , co testing for HR-HPV along with Thin prep or pap tests.

 Most HPV test gives results for 14 genotypes. By getting report of HPV 18 positive it means that HR-HPV test has been done.      

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·          Screening protocols should be read before letting labs recommend everything, Pap smear before 30 is good enough, and HPV is transient and should not be taken into account, if Pap smear is normal, repeat test after three years. If abnormal than you have d...

·         As, Dr Pal, I agree with you regarding assurance to the patient 

·         Should we insist on HPV serotype tests (Hybrid II Capture test) along with scheduled wet smear as is done 5 yarely. Relevance of Screening & adding HPV tests in addition to LBC??:- In most economically- sufficient countries initial dual screening is a common practice even in normal looking cervix (i.e. routine screening). It cost additional Rs. 2500/- only for HPV tests. In fact, if my relative is asked to undergo thin prep, I will advocate her to add HPV test as well. This will guide me about compulsion of subsequent screening.

·          The other reasons Why Co-testing (Pap & HPV-DNA) is desirable & relevant: The issue of life style modification if HPV test is also +ve: -- Testing for Pap (preferably- by Liquid Based Cytology (Pap- LBC) and concurrently HR –HPV(High Risk HPV)  test is very accurate and informs / warns about scheduling further subsequent screening. If HPV –DNA is +ve then, I have a feeling that I shall discourage the women concerned not to use OCP. Is that right? Opinion of Forum members please? I shall also counsel her on giving up smoking and if HPV +ve should be closely followed up for malig .changes.

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·         Regarding Co-testing opinion defers--This HPV test can be contemplated during routine Pap LBC test or a separate sample taken right after the Pap LBC. Usual Policy in India about HPV tests as on 2015:-

When to do? A) If borderline Pap LBC test result (tests shows unusual cells but not dysplasia).b) during routine screening for ca Cx screening and Pap smear. Women in their twenties do not need an HPV test in addition to the Pap test. HR HPV infection is very common in this age group and it usually goes away.

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Revisiting at Cx - by some serum marker in Virus induced CIN-instead repeated Colposcopy/ Cx biopsy: -a remote possibility?
Once, one of our forum members mentioned in this post that it should be clearly explained that the protection offered by any vaccine (especially regarding Ca Cx) cannot be expected to 100% and vaccination is NOT alternative option for screening. Incidentally, that member is working on identification of cofactors which prevent natural clearance of viruses and modifies viral activity.

Is there any serum Marker which can inform us about the activity of HPV virus which do remain at CX? ---The known cofactors which prevents spontaneous normal clearance of viruses from Cx are smoking, OCP intake? Spermicidal which causes chemical injury to epithelium of Cx-he added. In fact research should be oriented as to why few women fail to clear viruses of their own (like HBV)) and factors which predisposes to persistent cytological insults by the presence of virus. We, gynecologist are observing only the outward expression by carrying out Pap/ Colposcopy. Much research work remain to be done about dynamics of clearance of viruses .As a corollary , may I mention that there are some serum markers in HBsAg Chr. carriers which warns clinicians about the virulence / activity of Viruses. For instance, HbE presence shows activity of HBV in Liver and one can institute therapy at that juncture. But for Ca Cx only serial cellular abnormalities can give a guide to us yes, samples can be sent together. LBC and HPV DNA with the same sample .

 How to screen endocx? Why endocervical scrapings are difficult? Why it escapes screening??  Endocervical epithelium including glandular epithelium is not immune to Ca.  The problem which worries us  is that there is rising trend of endocervical Ca---which is  anatomically  difficult to screen .Many us do not use appropriate brush/ employ standard  ECC (endo cervical curette) along with Pap. This imprecise technique of collecting the sample can yield false negative result. The reason why there is a steady rise of endo Cx ca is unclear but the fact remains it is difficult to diagnose CIN at that site at an early stage not to speak of framing standard Screening protocol aiming at endocervical health. Can any forum member highlight on this aspect of screening-practical tips.

 Globally annual death rate due ca Cx is about 5, 00,000. Screening alone and if appropriate measures are adopted there can be reduction of death rate by 70% not the prevalence rate. Therefore, early diag is a distinct advantage if screening is duly implemented in a community. A 70% reduction is, in my opinion, a great achievement in screening tests.

A text Book (Danforth.10 Th Edition, 2008, lamented that absence of regular screening is associated with 2-6 fold increase in Ca Cx.  The editor also expressed concern about the fact that half of the newly disguised cases of ca Cx at US had never had Pap! To whom to blame? I have no answer.

Relation of HPV with occurrence of Ca Cx: - The same book has admitted that in 99.7% cases of diagnosed Ca Cx there was presence of HPV as documented by PCR. HPV DNA genome have 7,800 to 7,900 base pairs. Of the >100 types of HPV-only 30 subtypes infects anogenital region.HPV 16 & 18 accounts > 67% of all invasive ca Cx.-egulation of tumour suppressor gene. Over expression of the E6 and E7 viral proteins products cause inactivation of naturally occurring tumor suppressor proteins. May invite problem Bottom of Form