The National HPV & Cervical Cancer Campaign You Need to Know

September 26, 2011

The National HPV & Cervical Cancer Campaign is a public education campaign whose goal is to reduce the number of preventable deaths each year by cervical cancer through increased education, outreach and communication between women and their health care providers.

The National HPV & Cervical Cancer Campaign is a public education campaign whose goal is to reduce the number of preventable deaths each year by cervical cancer through increased education, outreach and communication between women and their health care providers. 

Clinical studies have confirmed that the human papillomavirus (HPV) is the primary cause of cervical cancer and is present in almost all cases of cervical cancer. Routine cervical cancer screening with up-to-date technologies can detect cervical cancer and its precursors early. When detected early, cervical cancer is virtually 100% curable. 

Each year in the U.S., over 2 million Pap tests are reported as inconclusive or ASCUS, which stands for Atypical Squamous Cells of Undetermined Significance. The guidelines developed by the American Medical Women's Association that follow are intended to provide information that women need to know should they receive an ASCUS Pap test result.

Patient Information for ASCUS PAP Tests - Information you need to know

Women deserve access to the best and most accurate testing methods available so that they can make the most appropriate health care decisions for themselves and their families. The goal of the American Medical Women's Association (AMWA) is to provide women with full and comprehensive health information and to raise awareness about cervical cancer, and the importance of regular, effective cervical screening and follow up care.

AMWA's recommendations for follow up care of ASCUS Pap tests are not intended as a substitute for medical advice. We have collected this information for patients with ASCUS Pap test results. We encourage every woman to consult her doctor or other health care professional about the follow up care that is best for her.

ASCUS
ASCUS stands for Atypical Squamous Cells of Undetermined Significance. ASCUS is a term used for Pap test results that the doctor is unsure about. Some cells appear different from a normal cervix under a microscope, but do not fit into a well-defined category. 

ASCUS is a very common Pap test abnormality and often means that there is no actual disease. However, ASCUS Pap results could be an early warning of a pre-cancer change (dysplasia) or cervical cancer, and should always be followed up. Follow up care options are described below.

HPV
Human Papillomavirus (HPV) is a group of over 70 known strains of virus. Certain strains of HPV called "high risk" cause 99.7% of cervical cancers. Other "low risk" strains cause genital warts. HPV is very common and is often transient. Most people with HPV will never know they are infected because these cases may resolve on their own. If "high risk" HPV types don't resolve on their own they may progress into pre-cancer cells. If these abnormal cells are not detected and treated they may become cancer with time. 

HPV is sexually transmitted. Approximately 30 HPV strains are spread through skin-to-skin contact, not just through contact of bodily fluids. Therefore, genital HPV cannot be effectively prevented by condom use.

Cervical Cancer
Cervical cancer is an uncommon, slow growing cancer that usually takes several years to fully develop. If caught in its pre-cancer stage, the abnormal cells (cervical dysplasia) are almost always easily treated and cancer doesn't develop. This helps to make cervical cancer the most preventable cancer in the United States. In fact, cases of cervical cancer have decreased by three-fourths since the introduction of the Pap test in the 1950's. While the Pap test can help find cervical dysplasia, it has shortcomings that can lead to missed disease or to unnecessary anxiety and over-treatment. That is why it is important to know what to do if you get an ASCUS result. 

If my Pap test result is ASCUS, what should I do?

1. Consult your physician or other health care professional
2. Consider your options

An abnormal Pap test does not mean you currently have, or will have, cervical cancer. Below you will find three possible methods of follow up for ASCUS Pap tests. AMWA recommends that all follow up care decisions be made in consultation with a physician or other health care professional.

Know Your Options

Repeat Pap Test (approximately $159.00)
The Pap test (sometimes called a Pap smear) is a way to examine cells collected from the cervix and vagina. A sample of cells is taken from in and around the cervix with a wooden scraper or a small brush, or 'broom.' The specimen (or smear) is placed on a glass slide or rinsed in liquid preservative and sent to a laboratory for examination. If any of the repeat Pap tests are abnormal then follow up colposcopy would be recommended.

$36.00 office visit x3      $108.00
$17.00 Pap test x3         $  51.00 
Total:                             $159.00

Benefit 

Availability - Pap tests are widely available and most physicians are familiar with them. 

Cost

Sensitivity - Conventional Pap tests have a high false negative rate; in other words, these results are often inaccurate.

Multiple Visits - Repeated visits for repeat Pap tests may be expensive, time consuming, and inconvenient.

Delayed Diagnosis - A false negative Pap test may delay the diagnosis and treatment of a precancerous or cancerous condition. 

Expense - Since it must be done 3 times, in addition to the original test, and requires an office visit each time, the combined cost is generally more than HPV testing (but less than colposcopy).

Possible Emotional Distress - Three tests done every 4-6 months takes at least a year to be sure everything is normal.

HPV Testing (approximately $48.50 - $84.50)
Similar to the Pap test, a physician or other health care professional collects cells from the cervix with a swab. The cervical cells are sent to a laboratory for evaluation. Alternatively, "reflex" testing can be ordered to be done automatically if a liquid based Pap test reveals an ASCUS result avoiding the need for a return visit. If the HPV test is positive for "high risk" HPV or the repeat Pap test is abnormal, then colposcopy would be recommended.

"Reflex" HPV test                $48.50
Return visit and HPV test     $84.50

Benefit 

Sensitivity - HPV testing is more sensitive than Pap testing in detecting severely abnormal cells. 

Specificity - A negative test provides strong reassurance that precancerous or cancerous cells are not present.

Single Visit ("reflex" testing) - Same Pap test specimens can be used to determine HPV results as well.

Expense - Total cost for this option is less than either repeat Pap tests or colposcopy. 

Cost

Possible Emotional Distress - Since there is no cure for HPV, definitive diagnosis may increase patient anxiety even though the majority of HPV infection resolves without treatment.

Availability - Since it is relatively new, some physicians or health care professionals may not be familiar with HPV testing or have the necessary supplies to collect the test.

Immediate Colposcopy (approximately $115.00 - $454.48) 
Colposcopy involves examination of the cervix and vagina with a lighted, magnifying instrument. A sample of tissue, or biopsy, may be taken and looked at under a microscope for precancerous or cancerous cells.

Colposcopy including office visit      $115.00
Colposcopy with biopsy                  $454.48

Benefit 

Definitive Diagnosis - A negative test provides strong reassurance that precancerous or cancerous cells are not present. A positive test provides an accurate diagnosis on which treatment can be based. 

Cost

Expense - Colposcopy is a costly procedure and is often unnecessary.

Risk of Medical Complications - Colposcopy may require a biopsy, and as with any medical procedure, there is risk.

Discomfort - While colposcopy rarely causes enough pain to require medication, some women do have significant discomfort with the procedure.

CONCLUSION: How to treat an ASCUS (Atypical Squamous Cells of Undetermined Significance) Pap test has been a major source of anxiety for patients and physicians. Most mild cervical abnormalities go away without treatment. However, we have had no way to determine which findings will go away and which mean more serious conditions - pre-cancer or cancer -- that need to be treated immediately. One way to decide this is to do HPV testing, a highly sensitive means of identifying abnormalities that need immediate attention, according to the ALTS (ASCUS/LSIL Triage Study) data from the National Cancer Institute.

COMBINATION TESTING: Together, an ASCUS Pap test followed by HPV testing should identify most patients with a higher risk of cervical cancer. Combined testing may also reduce unnecessary colposcopy tests in women with no disease. The confusion over what to do with the ASCUS Pap test is improved dramatically when followed by an HPV test.

Since HPV testing improves the chances of finding serious abnormalities, decreases the overall cost, and provides relatively quick and accurate reassurance to women without disease, AMWA recommends that HPV testing be done on women with ASCUS Pap test results. Repeat Pap tests should be reserved for situations in which HPV testing is not available. Colposcopy is a reasonable alternative for women who can only be reassured by a biopsy or who may have difficulty obtaining later follow up.

As reflex HPV testing further reduces overall cost and will not require further visits if there is a negative result, AMWA recommends that women request reflex HPV testing for an ASCUS result whenever a Pap test is done. 

Cervical cancer is preventable and virtually 100% treatable if detected early.

Note: This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. This information should not replace medical consultation and care with your physician or other health care professional or be used to dictate an exclusive course of treatment or procedure to be followed.