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Frank Bures: Comparison of Cervical Cancer Screening | Local



A new study comparing human papillomavirus (HPV) screening tests with the traditional Pap smear on cervical cancer in women (cervix cancer) was recently published in the Journal of the American Medical Association. Finding the best test has been a goal for years. This study included about 19,000 women who had either one test or the other. The results seem to take the HPV test more accurately and lack fewer "positives". (Is this test medically positive negative?)

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How Much Does It Cost Me, Doc?

Like any large number study, it generated opinions on both sides, and for some time, a single sample has often been collected for use in both investigations, called co-testing. Cervical Ca has been recognized as a very desperate cancer for centuries Cervical is the Latin word for the neck, cervix, and anatomically several parts of us are referred to as the cervix, just like the stem from your upper cov body holds your head. In a uterus, the lower narrow part, the channel through which Leroy or Lois glide on the way to the outside world, is the cervix.

Unfortunately, this uncanny, silent Ca in an invisible location is most often not seen to show symptoms or signs in the early stages. In later stages (too late) vaginal bleeding, pelvic pain or pain during intercourse may occur. Five-year survival rates in the US are 68 percent. It is the fourth most common cancer and fourth cause of death in women. It is expected that there will be 13,240 new US cases this year with 4,200 deaths. Today, it is believed that the cause in almost all cases of HPV or genital wart virus chronic infections is due to certain oncogenic (cancer) genotypic (generating) types. There are perhaps 200 known HPV strains. Oncogenes are types 16 and 18 in 70 percent of cases. There are about 12 types of carcinogens. Whether HPV vaccines can reduce the incidence of future cervical Ca is to be seen and hoped for. The same HPV types cause most anal cancers, many vaginal, vulvar and penile cancers and some oropharyngeal cancers.

Hippocrates wrote 400 BC that Cervix Ca was incurable. Ideas of the cause were far and wild over time. In the early 1900s, population studies favored that it was a sexually transmitted disease. Because it was rare among Jewish women, smegma, a collection of dead cells, oil, and "stuff," was postulated by uncircumcised men as the cause. In the 1960s, herpes simplex persisted in cervical cells and became the alleged culprit. It created a stigma for women who had "herpes". Tsk-tsk

In 1976, HPV DNA was found in cervical Ca and genital warts of zur Hausen, earning him a Nobel Prize. With more studies, it could be inoculated into laboratory animals to stimulate cervical Ca. Papanicoulaou, a Greek born pathologist, developed his technique to examine cells taken from the cervix in 1928. His presentation was, like so much new, set aside and only recognized in 1941, when he and a gynecologist, Traut, published a tome on women cancer

The main difference between a Pap smear and HPV tests is that the former Cells are microscopically analyzed for abnormal gradations from mild to malignant, now mainly after the Bethesda system of 1988. It is still made by humans who make judgments of what is seen. The HPV assays analyze tissues in a very complicated manner according to the particular methodology used for the submicroscopic DNA. The first is subject to random sampling and human error. The second is subject to laboratory technology / machine defects. Neither is 100 percent.

The goal of the study is good, but Co-Test collects from the same sample material for both tests. A gynecologist from New York commented on the slightly more diagnostic results with HPV and said that it still does not answer the critical question as to whether the HPV test alone is better than co-testing. Other smaller numbers could not guess this answer.

HPV infection is very common. Most infections are suppressed in 1-2 years without causing cancer. When it comes to high-risk strains, 10-20 years later, cells can become malignant. The HPV tries to detect the presence of the rogue virus while the Pap smear tries to discover its cellular footprints at various stages. Continuous co-testing seems to be most prudent, as long as our species lives rather coincidentally and not so carefully in coexistence. The race between the tests still seems to be "head to head".

Frank A. Bures is a semi-retired dermatologist in Winona.


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