Q: How have you performed cervical cancer screening in the past?
A: In the past we've done routine cytology and reflex high-risk HPV testing when atypia was present. And the reflex testing only provided us with a positive or negative for pooled high-risk HPV genotypes. It didn't give us a precise risk assessment.
Q: How has the cobas® HPV Test changed the way you care for patients?
A: Not only has the test changed the way I care for patients, but the study behind the test, the ATHENA trial, educated physicians about the incidence of high-grade lesions in women who had normal cytology results. Now that I can rely on the cobas® HPV Test to provide detailed and accurate information about a patient's risk, I can be much more aware and aggressive in evaluating patients for high-grade lesions.
Q: What is the value of knowing more about a patient's cervical cancer risk?
A: In the past, when patients would have persistently normal Pap results but a positive result for pooled high-risk HPV, they would become extremely anxious about the uncertainty of their risk and developing high-grade lesions. With the cobas® HPV Test, I can test them for HPV genotypes 16 and 18 specifically. And if these results are negative, I can reassure a patient that her risk is extremely low and decrease her anxiety.
Q: What are the benefits of being able to include individual HPV 16 and 18 genotyping in HPV tests?
A: In the past, it has been difficult to explain to a patient why we would test for pooled high-risk HPV genotypes but couldn't identify the highest-risk types individually to stratify risk. Now that we're able to do both, it has changed the way we counsel and manage patients. If a patient has an HPV 16 or 18 positive result from the cobas® HPV Test, I will perform a colposcopy with random biopsies. And on the other end of the spectrum, I tend to be less aggressive in my biopsies now when I know a patient isn't positive for HPV 16 or 18, the types that put her at the highest risk for developing a high-grade lesion. I can also provide my patients with more information from the cobas® HPV Test result so that they have a better understanding of why we need to perform more aggressive evaluations.
Q: How does the cobas® HPV Test HPV 16 and 18 genotyping inform your patient care decisions?
A: Overall, it allows me to focus my more aggressive efforts on the patients at highest risk to make sure I'm not missing anything and if there is something to find, we can treat it in its earliest stages. My patients appreciate being more informed about their HPV status. In accordance with the new cervical cancer screening guidelines, I can also now extend the interval at which I perform Pap and HPV testing because I have the results from the cobas® HPV Test telling me that a patient is at a very low risk for developing high-grade lesions over the next few years.
Q: How does knowing a patient's HPV 16 and 18 status affect your course of treatment and the use of invasive procedures?
A: Since using the cobas® HPV Test, I've performed fewer invasive colposcopies and random biopsies. When I was only able to get pooled results for high-risk HPV genotypes, I had to perform more random biopsies to better quantify a patient's risk. Now that I know the HPV 16 or 18 status of a patient, I can focus the more aggressive evaluations where they are most needed.
Q: How has knowing a patient's HPV 16 or 18 status helped you provide better care?
A: Before HPV 16 and 18 genotyping was available, I had several patients who persistently had atypia with high-risk HPV pooled results, but they would have negative colposcopies. And every year that they came back with atypical results, I would have to perform a colposcopy again. With the cobas® HPV Test, I can group patients with minimal risk or with high risk and I'm not performing colposcopies as frequently because of this. I recently had a patient with atypia and an HPV 16 positive result from the cobas® HPV Test. Her colposcopy looked normal, but knowing her risk of having a high-grade lesion was about 31%, I performed a four-quadrant biopsy and an endocervical biopsy and found a high-grade lesion. If I hadn't known her HPV 16 positive status, I wouldn't have gone further than the colposcopy and the high-grade lesion could have developed into a much more severe disease.
Dr. Litt serves as a paid speaker with the Roche Diagnostics Clinician Speakers Bureau and was compensated for his testimonial.
The information presented in this interview represents the opinions and medical decisions of the individual healthcare practitioner and is not intended to be a treatment recommendation by Roche Diagnostics or to serve as a substitute for the professional medical judgment of healthcare practitioners in the management or treatment of their patients.
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