CERVICAL CANCER SCREENING
Cervical cancer is the easiest female cancer to prevent, with regular screening tests and follow-up. Two tests can help prevent cervical cancer or find it early—
HPV Testing in HIV-Positive Women May Help Reduce Frequent Cervical Cancer Screening
July 22, 2012 — (BRONX, NY) — Compared to the general population, HIV-positive women have a high risk of cervical cancer and thus are advised to undergo more frequent screening tests. This creates a burden for HIV-positive patients and the health care system, leading to frequent biopsies, which often do not reveal clinically relevant disease.
A new study by researchers at Albert Einstein College of Medicine of Yeshiva University suggests that HIV-positive women may be able to use new methods that can help to safely reduce the frequency of screening in some women, similar to practices accepted in the general population. The findings will be published in the July 25 issue of the Journal of the American Medical Association (JAMA), a theme issue on HIV/AIDS.
Howard Strickler, M.D., M.P.H., professor of epidemiology & population health at Einstein and senior author of the study, presented the findings today at a JAMA media briefing at the International AIDS Conference.
As of 2009, 1.2 million people age 13 and older were living with HIV in the United States, according to the Centers for Disease Control and Prevention. Women accounted for about one-quarter of those infected.
In March 2012, the United States Preventive Services Task Force revised its cervical cancer screening guidelines for HIV-negative women aged 30 or older to once every five years from once every three years provided they have a normal Pap smear test and a negative test for human papillomavirus (HPV), the virus mainly responsible for cervical cancer. The Pap test detects precancerous or cancerous changes in the cervical lining and the HPV test detects cancer-associated types of the virus.
But those guidelines did not update screening recommendations for HIV-positive women. Current recommendations for HIV-positive women are to have two Pap tests, at six-month intervals, in the first year following diagnosis of HIV and, if normal, on an annual basis from then on. HPV testing is not currently recommended for HIV-positive women.
The current study looked at whether cervical cancer screening could be reduced in HIV-positive women who have a normal Pap test and a negative test for HPV. The Einstein researchers reasoned that for women with a normal Pap test and no evidence of cervical HPV infection, the risk of cervical precancer or cancer is likely to be very low for several years regardless of HIV status.
Howard Strickler, M.D., M.P.H."It is widely thought that before cervical precancer or cervical cancer can develop, there must be persistent infection by a cancer-associated HPV, as well as the accumulation of additional genetic changes over time," said Dr. Strickler.
The study analyzed data on 420 HIV-positive and 279 HIV-negative women who were enrolled in the Women's Interagency HIV Study (WIHS), the largest prospective study of HIV-positive women in the US. (Montefiore Medical Center, the University Hospital for Einstein, is one of the six clinical sites for WIHS.) At enrollment, each woman had a normal Pap test and tested negative for the cancer-related HPV types. The women's rates of cervical precancer and cancer were measured after three- and five-years of follow-up.
At both the three- and five-year screening intervals, the incidence of cervical precancer was found to be similar in both HIV-positive and HIV-negative women. No cases of cervical cancer were detected in either group.
"These data raise the possibility that HPV and Pap co-testing could be used to reduce the burden of frequent Pap tests and, by extension, unnecessary biopsies in HIV-positive women who are in long-term clinical follow-up."
– Marla Keller, M.D.
"Overall, few cases of cervical precancer would have gone undiagnosed if the HIV-positive women did not have any additional Pap tests during the five years following enrollment — no more than in the HIV-negative group," said lead author Marla Keller, M.D., associate professor of medicine and of obstetrics & gynecology and women's health at Einstein and attending physician, medicine at Montefiore. "Thus, these data raise the possibility that HPV and Pap co-testing could be used to reduce the burden of frequent Pap tests and, by extension, unnecessary biopsies in HIV-positive women who are in long-term clinical follow-up."
ZIMBABWE - CERVICAL CANCER A MAJOR THREAT TO HIV-POSITIVE WOMEN
February 2013 (PlusNews) - HIV-positive women are living longer, but are now
dying of cervical cancer. In
Zimbabwe, cervical cancer is now the most common cancer among women,
particularly those living with HIV. Activists are urging the
government to step up efforts to prevent deaths related to the disease,
accusing it of paying lip service to the problem.
According to the Zimbabwe National Cancer Registry, cervical cancer affects about 30 percent of women in the country. Cervical cancer is caused by the sexually transmitted human papilloma virus (HPV). Although condoms are said to lower the risk of getting HPV, they do not prevent the risk of acquiring this virus completely. About 1,900 women are diagnosed with the disease every year in Zimbabwe and 1,300 die, according to the UN World Health Organization.
Efforts poorly resourced
In October last year, the government registered a cervical cancer vaccine for the prevention of HPV and reported that by early this year the new vaccine would be available for women in the country. However, those plans have been scuppered by financial constraints.
A number of public health institutions
in Zimbabwe, including Parirenyatwa Hospital, the country's largest referral
hospital, were supported by the UN Population Fund (UNFPA) to run free cervical
cancer tests known as visual inspection with ascetic acid and cervicography.
While this method is faster and cheaper than the traditional pap smears, the
machines at Parirenyatwa Hospital are not enough to service the large number of
women coming from around the country for the service. Women have been forced to
wait for up to a month to get screened.
In addition, some women who had been screened and found to have cervical cancer have been waiting for up to three months for treatment. One woman at the hospital, who asked not to be identified, told IRIN/PlusNews that after waiting for three months to begin her treatment, she was told the radio therapy machines had broken down and had to wait again until the machines were repaired.
AIDS activist Promise Mthembu noted
that research indicated that more women in sub-Saharan Africa are dying of
cervical cancer than of maternal mortality-related deaths. She urged the Zimbabwean
government to do more to address this growing crisis.
“Before HIV/AIDS, cervical cancer was a disease of older women, affecting women beyond reproductive age, and it was marginalized because of this. But now it is affecting younger women,” said Mthembu.
“It is important that we have a comprehensive package for women that addresses cervical cancer. What we have seen in HIV/AIDS policy is that policy has been promoting pap smears or screening for cervical cancer. While a pap smear is a means to an end, why should the government screen cervical cancer if it doesn’t have means to treat cervical cancer?”
Oncologist and cancer-prevention activist Anna Nyakabau says it is unacceptable that a large number of women continue to die as a result of cervical cancer given the slow progression of cervical cancer in a person’s body.
According to Nyakabau, many women are dying in Zimbabwe because they present themselves to health facilities when it is too late to save their lives. She says the disease is evasive because symptoms only show when the disease is already at an advanced stage. She says it is important for the government and its partners to increase knowledge among the population about the dangers of cervical cancer and the importance of regular screening for the disease.
Minister of Health and Child Welfare Henry Madzorera admitted that lack of funds had stymied the roll-out a cervical cancer vaccine early this year, but said the government would be mobilizing funds from donors to launch the vaccine in 2014. Meanwhile, he said, the government would focus on other strategies to reduce cervical cancer deaths in the country, such as screening and testing and treatment for those infected.