Professor Peter Sasieni says women vaccinated for HPV may only need two cervical cancer screening tests during their lifetime
Here’s a spicy new subject for debate among pathologists and women’s health specialists. Would it be safe for a woman who has been vaccinated for HPV (human papillomavirus) to get just two cervical cancer screening tests in her lifetime—one at age 30 and the other at age 45? A prominent professor in the United Kingdom recently advocated just such a medical laboratory testing protocol.
Earlier this month, at the United Kingdom’s National Cancer Research Institute conference in Liverpool, England, Professor Peter Sasieni made a presentation about HPV vaccinations and cervical cancer screening that generated press headlines throughout the United Kingdom. Sasieni believes enough progress has been made in vaccinating young women for HPV in the U.K. that it would be clinically appropriate to change the current guidelines for cervical cancer screening.
Changes to How Clinical Pathology Laboratories Provide Pap Testing
For women vaccinated against HPV, Sasieni—who is a professor at Queen Mary University of London and an expert in statistics and cancer epidemiology—says that performing an HPV test at age 30 and at age 45 would provide adequate detection of cervical cancer. The HPV test Sasieni has in mind detects 13 strains of HPV. “If you don’t have one of these 13 types of HPV, then your chance of getting cervical cancer in the next 10 years is really incredibly low,” stated Sasieni in a press interview.
“You would capture virtually everybody [at risk for cervical cancer] with HPV screening,” continued Sasieni. “Vaccinated women would only need to be screened when they are 30 and 45.”
In the United Kingdom, the uptake of HPV vaccinations has been quite high. The BBC reported that, for school-age girls, vaccination rates are 80% in England and 90% in Scotland. Since both countries have a high rate of HPV vaccination, experts like Sasieni are considering whether it might be appropriate to make changes to existing cervical cancer screening protocols.
“With continued high coverage of HPV vaccination and targeting of screening resources towards unvaccinated women, cervical cancer should become a truly rare disease,” commented Sasieni. “And if the government plan for this change now, it could save hundreds of million of pounds in the long run.”
The opportunity to save money by reducing the frequency of cervical cancer screening was discussed. However, Professor Julietta Patnick, who is Director of the NHS Cancer Screening Programs in the United Kingdom, offered a more conservative view. “Any plans to use HPV testing as the primary screening method will require rigorous investigation and testing, as well as the development of robust quality assurance protocols and standards before it could be implemented.”
Widespread HPV Vaccination May Mean Fewer Tests for Medical Labs
Now that HPV vaccines have been available for several years, it is not surprising that some medical professionals are assessing how this development might influence existing cancer screening recommendations. In the United Kingdom, GlaxoSmithKline’s Cervarix is part of the nation’s HPV vaccination program. It was approved for use in the European Union in 2007. Gardasil is Merck & Co.’s HPV vaccine and was cleared for the U.S. market by the FDA in 2006. Both vaccines require three injections, each several months apart.
In the United States, HPV vaccinations involve a much smaller proportion of the female population, compared to the United Kingdom. A study of HPV vaccinations involving young women was recently published. The study was performed at the University of Maryland and looked at 10,000 women aged 9 to 26 who were eligible for HPV vaccination.
The lead researcher was J. Kathleen Tracy, Ph.D., who is Assistant Professor of Epidemiology and Public Health at the University of Maryland. She reported that only 30.78% of the women who started the HPV vaccination regimen completed each of the three doses required for full protection.
In the British press coverage of Sasieni’s recommendations, it was noted that his suggestions would greatly reduce the number of cervical cancer screening tests currently performed in that country. This would save the National Health Service considerable sums of money that it now spends on clinical pathology laboratory tests associated with cervical cancer screening.
Going forward, pathologists and clinical laboratory managers may want to monitor how the United Kingdom might change existing cervical cancer screening guidelines in response to a growing proportion of young women in that nation who are vaccinated for HPV. This type of debate is years away from happening in the United States, due to the much lower number of women who have been vaccinated for HPV.