Q: How have you performed cervical cancer screenings in the past?
A: I typically have done Pap cytology every year on every woman over the age of 18 and reflex HPV testing on patients who have ASC-US Pap results or are over the age of 30. We hadn't performed HPV genotyping until we had access to the cobas® HPV Test in April 2012.
Q: How has the cobas® HPV Test changed the way you care for patients?
A: Overall, the cobas® HPV Test has allowed me to better stratify my patients' risk for developing cervical disease by telling me if they have one of the highest-risk HPV genotypes, 16 or 18. Before we were able to get these kinds of results, we were essentially blind when trying to manage patients. Now, if a patient screens positive for HPV 16 or HPV 18, I can decide to take them straight to colposcopy to do a more thorough examination rather than waiting a year to see them again for their annual examination.
Q: What is the value of knowing more about a patient's cervical cancer risk?
A: Knowing a patient's precise risk for cervical cancer allows for better care and management. When you know a patient is at a higher risk for developing cervical disease, you have a better idea of how aggressive to be in your evaluation, whether that means performing a colposcopy or random biopsies. And when I can tell a woman her exact risk and discuss what that means, I'm able to encourage better ongoing compliance with that patient, ultimately giving her the best care possible and making sure she feels confident that she's getting all necessary information and treatment.
Q: The cobas® HPV Test is a valuable complementary tool to a Pap test in cervical cancer screening. How does earlier identification of HPV, particularly HPV 16/18, affect your treatment decisions?
A: Earlier identification of HPV allows for more immediate action in managing my patients' care. If a patient has a negative cytology result but screens positive for HPV 16 or HPV 18 with the cobas® HPV Test, I no longer need to repeat any tests or wait for additional results, I can perform a colposcopy sooner and any random biopsies if necessary to get a better idea of the patient's precise risk. And having this information helps me impress upon the patient what her risk is to help her realize how important ongoing follow up will be.
Q: Have you had an experience where Pap testing didn't provide adequate information for diagnosis and treatment?
A: Before we had the ability to perform genotyping with HPV testing, I had several patients over 21 that had ASC-US Pap results persist annually in their examinations, but we weren't able to find the abnormalities with a colposcopy. At that point, I performed a LEEP procedure on a patient and found she had carcinoma in situ of the cervix. Had I been able to identify that patient's HPV 16 or HPV 18 status earlier with the use of the cobas® HPV Test, she could have been treated earlier and the disease might not have progressed as far.
Q: What value does the 3-in-1 cobas® HPV Test provide over pooled high-risk HPV test results in women ages 30-65 for whom co-testing is ordered?
A: The simultaneous 16/18 genotyping makes it easier for me to follow the recently updated ACOG guidelines for cervical cancer screening, which recognize the benefits of genotyping for HPV16 or HPV16/18 in this population. Having HPV 16 and 18 results for co-testing patients enables me to divide my patients into specific subgroups based on their risk and focus my efforts and management on those who are at the highest risk. And I've seen from my patients that they prefer being given the specific numbers and percentages of their risk because it reassures them that I am spot on with my assessment and that I can provide the best care based on these details. And in regard to the new cervical cancer screening guidelines recommending that women ages 30 to 65 be co-tested with HPV and cytology every five years, I feel more comfortable letting that amount of time go by between screenings when I know I have the result from the cobas® HPV Test showing me that patient is negative for high-risk HPV genotypes.
Dr. Hamilton 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.
Chief of Staff, Summit Medical Center Nashville, TN