University of Virginia Health System

U.VA. RESEARCHER'S EDITORIAL PUBLISHED WITH NEW CERVICAL CANCER GUIDELINES IN JAMA

Breakthroughs in cervical cancer screening procedures and clearer terminology have resulted from the recently reported findings of several clinical trials and nationwide debate among clinicians and pathologists specializing in cervical pathology. Today's Journal of the American Medical Association (JAMA) features two articles about these advances and an editorial authored by Dr. Mark H. Stoler, professor of pathology and clinical obstetrics and gynecology at the University of Virginia Health System, who was co-investigator with the NCI researchers on one of the clinical studies.

Pathologists and clinicians have long struggled to deal with equivocal diagnoses of cervical cancer screenings, Stoler said. The new guidelines mark a new beginning for reporting and treatment of cytological abnormalities, and hopefully may lead to eradication of cervical cancer.

Stoler's editorial explains the context and implications of the proposed new guidelines and terminology clarifying test abnormalities, which were developed in part from a study conducted by researchers at the National Cancer Institute and several universities.

The NCI study that Stoler helped lead determined the benefits of combining testing for human papillomavirus (HPV) with traditional Pap tests to screen women's risk for cervical cancer. In findings from the study, approximately half of all women who have equivocally abnormal Pap test results have a lesion that further testing for HPV, which causes cervical cancer, would help identify. Statistics show that as many as 2.5 million American women have these mildly abnormal Pap tests each year.

HPV is a factor in more than 95 percent of cervical cancer cases. However, up until now, the utility of testing for HPV was not well defined, Stoler said. Because of this uncertainty about whether it was useful, some women who really were at risk may have been unidentified. Others were tested unnecessarily because of false positive results from their Pap smears, and really did not need the additional tests. The NCI research clarified the situation with data that clearly demonstrate that patients with the most common mild abnormality on Pap smear can be effectively triaged by the HPV test.

The (JAMA) articles acknowledge that HPV testing has been clinically validated and can become integral to both screening and clinical management, Stoler's editorial said.

The new guidelines include a revision of the National Institutes of Health Bethesda System terminology used since 1991 for reporting results of cervical cytology screening. The new terminology better defines the parameters of screening, and is a starting point for continued refinement of classifying abnormalities and other screening factors, Stoler wrote.

Input from pathologists, gynecologists and other specialists in cervical disease from the World Wide Web, as well as the NCI research study data, directly influenced test result management guidelines published in JAMA, Stoler said. The guidelines came out of a 2001 consensus conference conducted by the American Society of Colposcopy and Cervical Pathology.

As a result of all these recent efforts, women now can have better cervical cancer screening, clearer test interpretations and more effective management of their results, Stoler said. This can increase prediction power in ways that can improve outcomes and potentially reduce costs. It's a big step toward making cervical cancer preventable.

According to the American Cancer Society, approximately 12,800 women in the United States were diagnosed with cervical cancer last year, and about 4,600 women died from the disease. When found and treated early, cervical cancer often can be cured.

April 23, 2002