National Association of Nurse Practitioners in Women’s Health Urges Support for HPV Testing
WASHINGTON, Jan. 16 /PRNewswire/ — After a revolutionary year for cervical cancer prevention, the National Association of Nurse Practitioners in Women’s Health (NPWH) is announcing its endorsement of cervical cancer screening guidelines that support the use of HPV (human papillomavirus) testing along with the Pap for routine screening of women 30 and older. NPWH is taking the lead in educating the broader medical community, including nurses, by speaking out on this issue. Its recommendations follow guidelines released recently by several leading medical groups, including the American Society for Colposcopy and Cervical Pathology (ASCCP), American Cancer Society and American College of Obstetrics and Gynecology (ACOG).
“As more data emerges documenting that cervical cancer can be prevented and how, it is increasingly important for women of all ages to know the facts — including which prevention and detection strategies are appropriate for them,” said Susan Wysocki, RNC, NP, President and CEO. “While the Pap test is still a good tool, we recognize it is not perfect. This is why we support expanding routine screening to include the HPV test for women 30 and older, who are at highest risk of developing cervical cancer.”
While Pap smear screening has significantly reduced deaths from cervical cancer over the last 60 years, the conventional Pap test can still miss detecting disease. Even with the newest technology using liquid-based Pap many experts note that the accuracy of a single Pap smear for detecting a pre-cancerous lesion is between 75 and 85 percent. In contrast, recent studies show that combining the HPV test with a Pap improves screening accuracy to virtually 100 percent.
“Screening should be age appropriate,” said NPWH Board Chair, Anne Moore, RNC, MSN. “It is persistent infection that can lead to more serious disease. Therefore, in younger women (under 30), HPV testing is recommended as a follow-up to the traditional Pap smear. However, in women over 30, where the presence of high-risk HPV types often indicates that the infection has not been resolved, it is recommended to use both the HPV test and the Pap test.”
Women who are found to carry a high-risk type of HPV can be monitored more closely and treated if necessary before cancer develops. On the other hand, women who do not have HPV and whose Pap smears are normal have been shown to have virtually no risk of disease — offering extra peace of mind. Periodic re-testing is needed, however, since a new HPV infection may be acquired or an older one may be “dormant” until re-activated.
NPWH also recognizes guidelines associated with the new HPV vaccine for girls age 9 through 26. However, it strongly recommends that healthcare professionals continue to screen all women with the Pap and (in age-appropriate women) HPV tests regardless of whether they have received the vaccine.
Cervical Cancer Screening ‘for Life’ Below are the guidelines for HPV testing endorsed by the NPWH: Women 30 and Older — Routine Screening with Both Pap and HPV DNA Testing
Given the increased sensitivity, women 30 and older may benefit from expanded screening using both a Pap and the HPV DNA test. In this case, the HPV test is performed regardless of the Pap result and both tests are used to determine the timing of the next screen or the need for colposcopy.
* Women whose HPV test is negative and whose Pap smear is normal do not need to be re-tested for three years. (Women who get just the Pap need to be tested more frequently.)
Women of all Ages — HPV Testing Following an Inconclusive (ASC-US) Pap Test Result
* It is appropriate to test for HPV in women of all ages for triage of an inconclusive or borderline Pap result. * Women with an inconclusive Pap who test positive for HPV should be evaluated further with a colposcopy. Those who test negative for HPV should have their Pap repeated in one year. Women Who Have Received the HPV Vaccine * NPWH strongly recommends that healthcare professionals continue to screen all women with a Pap and (if 30 or older) the HPV test, according to these guidelines — regardless of whether they have received the vaccine. Success Lies in Open Dialogue
The NPWH is also the first national group to call for broad, routine patient education about HPV and cervical cancer screening, including prevalence of HPV and its lifecycle, overall risk for HPV and cervical cancer, the purpose of each screening test performed and the importance of adhering to recommended screening intervals.
“As nurse practitioners, we have the opportunity to bridge the gap so that women not only receive the most accurate tests, but are also informed about them,” said Wysocki.
“Today cervical cancer most always occurs in unscreened or under-screened women. Women’s awareness of their risk and the need for screening is key to the success of any prevention program. Educating women about their options, including combination screening with both the Pap and HPV tests for women 30 and over — as well as the HPV vaccine — is imperative for reducing the incidence of this disease that needlessly affects thousands of women each year,” adds Moore.
About Cervical Cancer and HPV
It is well established that persistent high-risk HPV is the cause of cervical cancer. HPV is the most common sexually transmitted infection and most women are infected at some point in their lives, although it is usually fought off or suppressed by the body’s immune system in a relatively short time. The peak age for HPV infection is in the mid-20s and the peak incidence of cervical cancer is 10 to 15 years later, in the 40s and 50s. However, cervical cancer is a rare occurrence, even when infection with high-risk types of HPV persists. The American Cancer Society estimates that in 2006, about 9,700 women in the United States developed cervical cancer and about 3,700 died from the disease. Worldwide, cervical cancer is the second-most-common type of cancer that strikes women — behind only breast cancer.
About NPWH
Founded in 1980, the mission of the National Association of Nurse Practitioners in Women’s Heath (NPWH) is to assure the provision of quality health care to women of all ages by nurse practitioners. NPWH defines quality health care to be inclusive of an individual’s physical, emotional, and spiritual needs. NPWH recognizes and respects women as decision-makers for their health care. NPWH’s mission includes protecting and promoting a woman’s right to make her own choices regarding her health within the context of her personal, religious, cultural, and family beliefs.
National Association of Nurse Practitioners in Women’s Health
CONTACT: Megan Lynch of Lippe Taylor, +1-212-598-4400 x171,mlynch@lippetaylor.com, for National Association of Nurse Practitioners inWomen’s Health