Content deleted Content added
→Mum's the word?: addendum |
→Incorrect Information: revise problematic markup |
||
Line 237:
You have a lot of comments, so let me try to respond one by one:
In addition: I have to disagree on one significant point. I consider sensitivity to be of equal importance to specificity. I – and my patients – would prefer to be told that they might be at risk, and then find out later they are fine, than to be surprised later with a diagnosis of invasive cancer. Most of the experts who speak at conferences on this topic agree. (Sensitivity is particularly important in low-resource countries, where frequent medical visits by women are not practical and a broader definition of “at-risk” is needed.)
Thus, see my revised edited copy below:
However, it is not a perfect test. "A nurse performing 200 tests each year would prevent a death once in 38 years. During this time she or he would care for over 152 women with abnormal results, over 79 women would be referred for investigation, over 53 would have abnormal biopsy results, and over 17 would have persisting abnormalities for more than two years. At least one woman during the 38 years would die from cervical cancer despite being screened."[2] In addition, 2005 study published in the Journal of the National Cancer Institute found that 32% of invasive cervical cancers were due to Pap detection failure. Testing for HPV along with the Pap for women over 30, as well as the HPV vaccine, may offer better prospects in the long term.
•••
By adding the more sensitive HPV test, the specificity (correlation with actual disease) may decline. However, the drop in specificity is not significant.7
•••
Randomized, controlled trials have shown that the HPV test is significantly more sensitive in identifying women with cervical disease (CIN 2, 3 or cancer) than cytologyError! Bookmark not defined.,Error! Bookmark not defined.. It is FDA-approved for use along with the Pap for routine screening of women 30 and over, or as a follow-up evaluation of women of all ages with inconclusive cytology results.▼
▲Randomized, controlled trials have shown that the HPV test is significantly more sensitive in identifying women with cervical disease (CIN 2, 3 or cancer) than cytologyError!
Abnormal cell changes (called dysplasia or cervical/endocervical intraepithelial neoplasia) are almost exclusively caused by sexually transmitted human papillomaviruses (HPV).Error! Bookmark not defined. The Pap is designed to detect the existence of cervical cancer or potentially pre-cancerous lesions by sampling cells from the outer opening of the cervix (Latin for "neck") of the uterus and the endocervix.▼
•••
▲Abnormal cell changes (called dysplasia or cervical/endocervical intraepithelial neoplasia) are almost exclusively caused by sexually transmitted human papillomaviruses (HPV)
•••
In the United States, medical guidelines generally recommend that females begin getting an annual Pap smear three years after they first become sexually active or at the age of 21, whichever comes first. Practices differ in other countries, with routine Pap testing often recommended every three to five years. If a Pap result is inconclusive or appears abnormal, further evaluation is needed with repeat cytology or – as many experts now recommend -- an HPV DNA test (which looks for the presence of the virus that is the primary cause of cervical cancer). Whatever method is used for follow-up evaluation – repeat cytology or HPV DNA testing – a colposcopy exam is normally performed if results are abnormal.
The HPV DNA test also is approved in the United States for routine screening of women over 30, when they are most at risk of developing cervical cancer, along with a Pap. If both the Pap and HPV test results are normal, U.S. guidelines recommend re-testing once every three years. Research conducted in Europe and elsewhere, however, suggests that re-testing could be delayed even further – to five or six years – since the HPV DNA test is so sensitive in identifying women at risk.
•••
A report in the International Journal of Cancer found that about one-third of cervical cancers occurred in women whose last Pap smears had appeared normal. In the United States, physicians who fail to diagnose cervical cancer from a Pap smear have been convicted of negligent homicide. In 1988 and 1989, Karen Smith had received Pap smears which were argued to have "unequivocally" shown that she had cancer; however, the lab had not made the diagnosis. She died on March 8, 1995. Later, a physician and a laboratory technician were convicted of negligent homicide. These events have led to even more rigorous quality assurance programs, and to emphasizing that this is a screening, not a diagnostic test, associated with a small irreducible error rate. This concern about missing pre-cancerous cells and cancer has also been one of the driving forces behind increased adoption of HPV DNA testing in addition to cytology for older women.
A study published in April 2007 suggested the act of performing a Pap smear produces an inflammatory cytokine response, which may initiate immunologic clearance of HPV, therefore reducing the risk of cervical cancer. Women who had even a single Pap smear in their history had a lower incidence of cancer. "A statistically significant decline in the HPV positivity rate correlated with the lifetime number of Pap smears received. [Moved up from the HPV testing section.]
•••
Studies of the accuracy of conventional cytology report:
Studies of the accuracy of liquid-based cytology report:
Studies of the accuracy of HPV testing report:
[[Special:Contributions/71.224.215.219|71.224.215.219]] ([[User talk:71.224.215.219|talk]]) 20:08, 28 April 2008 (UTC)
'''EDIT WARNING''' Various problematic markup revised and reflist-talk dropped below. — [[user:MaxEnt|MaxEnt]] 21:18, 18 May 2020 (UTC)
{{Reflist-talk}}
== Karen Smith ==
| |||