College of American Pathologists
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HPV screening seminar a success

January 2003
Diane D. Davey, MD

With over 210 attendees, the September CAP Strategic Science seminar “HPV screening: Are you ready for a new era in cervical cancer screening?” was filled to capacity. The conference organizers were gratified by the interest and regretted that not everyone could be accommodated. To purchase conference notebooks containing abstracts and Powerpoint handouts ($75 for members, $100 for nonmembers), call the CAP education department at 800-323-4040 ext. 7525.

Proceedings of the seminar will appear in Archives of Pathology & Laboratory Medicine, and a half-day seminar summarizing the conference will take place during the fall 2003 CAP meeting in San Diego.
The era of human papillomavirus testing represents a paradigm shift in cervical cancer screening and followup studies. HPV is a necessary but not sufficient agent for the development of cervical cancer. Many women become infected with HPV, but only a few develop high-grade squamous intraepithelial lesions or cancer. Persistent infection (lasting at least 11/2 years) with an oncogenic HPV means a woman has a good chance of developing a high-grade lesion or cancer.

Speakers at the conference discussed appropriate uses for HPV testing, including the recently published clinical management guidelines developed under the leadership of the American Society for Colposcopy and Cervical Pathology. In patients with atypical squamous cells of undetermined significance, HPV testing is at least as sensitive as immediate colposcopy in detecting biopsy-proven high-grade lesions. HPV testing is more sensitive than cervical cytology as a primary screening tool, although the FDA has not yet approved it for this use. Combined cytology and HPV testing offers nearly 100 percent negative predictive value in excluding high-grade lesions. Patient advocate Nancy Roach discussed patient and public health educational issues. Many women know little about the role of HPV in cervical carcinogenesis.

Strategic Science, a multimodal continuing education series, integrates science with laboratory management and includes an online pre-conference. September Strategic Science speakers addressed HPV testing methods, new technology assessment, quality assurance, regulatory compliance, risk management and safety, billing and coding, cost analysis, information management, and results reporting. As speakers stressed, there is no universal answer to the question: Should HPV tests be performed in-house or sent out? Laboratories must consider volumes, local clinical practices and expectations, and payer mix, among other issues.

Dr. Davey is past chair of, and former advisor to, the CAP Cytopathology Committee and professor of pathology and laboratory medicine and laboratory director of the cytopathology and bone marrow laboratories at the University of Kentucky Chandler Medical Center, Lexington.