Cervical cancer Is the HPV test useful?

The benefit of the HPV cervical cancer screening test is being re-examined

03/26/2014

Human papillomaviruses (HPV) are the main cause of cervical cancer (cervical carcinoma). Nevertheless, the HPV test is not part of the statutory screening program, not least because there are doubts about its validity and he can not replace the so-called PAP test (special swab test) as an examination method, reports the cancer information service of the German Cancer Research Center (DKFZ) in Heidelberg , Women who still want to have an HPV test usually have to pay for it themselves. „Whether the detection of human papillomavirus could not reasonably be used for the early detection of cervical cancer“, is being re-examined, according to the Communication from the Cancer Information Service.

Even today, some health insurance companies assume the costs for an HPV test under certain conditions, although this is not one of the legally required screening tests. In most cases, the test is offered by gynecologists as Individual Health Benefit (IGeL), for which up to 70 euros are due. Even a positive finding, however, says little about the cancer risk in case of doubt. Because HPV infections are not uncommon and they do not necessarily lead to cervical cancer. According to the experts of the German Society for Gynecology and Obstetrics, the test can still make an important contribution to the early diagnosis and prevention of cancer under certain conditions. According to the Cancer Information Service, the Institute for Quality and Efficiency in Health Care (IQWiG) has also found evidence that women can benefit from an HPV test in the context of cancer screening. However, no recommendation for a specific investigation strategy can be derived from the available research results so far.

Positive HPV test alone with little significance
A positive finding from the HPV test, according to the Cancer Information Service „in healthy women with inconspicuous findings in the smear examination currently no significance for early detection.“ Because this does not show whether the infection is only temporary or threatens long-term tissue changes. In particular, in women under the age of 30, the test result is not very meaningful because „a result that is positive today will soon be negative again“ could. It is also easy infection after the test is possible, so that it offers no reliable statement. In addition, no immediate therapeutic measures can be deduced from the test because no drugs are known to treat the viruses. Only when tissue changes actually form, is it possible to treat them. Under certain circumstances, the HPV test can provide important information for early detection, making it much easier to treat. Even after surgery for cervical cancer, regular HPV testing is a good way to monitor the success of the treatment.

Health insurance companies pay HPV test under certain conditions
Although so far no comprehensive assumption of costs of the HPV test by the legal health insurance is provided, the health insurance companies carry the investigation costs under certain condition already today. This applies, for example, according to the information provided by the Cancer Information Service, „if the doctor finds conspicuous cells during the examination that can not be clearly assessed.“ Here help the test, „to clarify the findings more precisely and to determine further treatment.“ The health insurance companies are also paying the HPV test „in patients undergoing cervical cancer or pre-cancer“, The Cancer Information Service continues to report. However, the German Society for Gynecology and Obstetrics generally recommends the HPV test for women over the age of 30, as they are at an increased risk that the pathogens stay longer in the body and thus cause cell changes. If the test is negative, so no pathogens can be detected, the women might have „not every year, but possibly after two to five years to the next cervical cancer screening“, so the message from the Cancer Information Service. Here is a reimbursement by the health insurance but not guaranteed.

Most successful cancer test ever
Although the HPV test may well be a useful addition to conventional cervical cancer screening, the PAP test remains essential as a standard diagnostic test. „With the help of this simple smear of the cervix and cervix, pathologically altered cells can be detected, which can develop into cancer precursors“, reports the Cancer Information Service. However, cervical cancer does not necessarily have to be present in the case of a conspicuous result in the PAP test. Often, inflammation is the cause of tissue changes. Further investigations must follow in this case in order to arrive at a certain diagnosis. The Pap test is valid, according to the Cancer Information Service „as most successful cancer testany times.“ He also has weaknesses. Sometimes lighter tissue changes are overlooked, which is why the examinations should be repeated regularly. In addition, the test in rare cases falsely give a positive result.

Significant decline in deaths
Overall, the number of cervical cancer deaths has been halved in the forty years since the introduction of the PAP test. According to the Robert Koch Institute (RKI), 1,524 women died of cervical cancer in 2010. The annual number of new cases is around 4,600 cases. Since the 1980s, according to the RKI, a continuous decline in the mortality rate can be observed and the „relative 5-year survival with invasive cervical carcinoma is 69 percent.“ The increased chance of survival is not only a result of the improved medical possibilities, but also the result of comprehensive early detection programs, reports the RKI. (Fp)

Picture: Gerd Altmann