The American Cancer Society estimates that 9,700 women will be diagnosed with cervical cancer and 3,700 will die of this disease in the year 2006. Fifty years ago, cervical cancer was the leading cause of cancer-related deaths in our country. Since then, the number of deaths due to cervical cancer has decreased by almost 75%
This impressive decline is directly related to the introduction of the pap smear, a cytologic test whose primary goal is the detection of precancerous lesions that can be easily treated before becoming invasive. In developing countries, however, pap smear screening is not widely available. Cervical cancer therefore remains a leading cause of cancer related-death, killing approximately 250,000 women worldwide each year.
Extensive research over the past 20 years has provided strong evidence that persistent infection with high-risk Human Papilloma Virus (HR-HPV) represents the major etiologic factor in the development of cervical dysplasia and carcinoma. Genital HPV infections are estimated to be the most common sexually transmitted infection in the US with 5.5 million persons becoming newly infected each year. The lifetime cumulative risk of HPV infection is at least 80%, with a transmission rate of up to 26% after a single sexual encounter. Typically, infection is usually transient, with greater than 90% of HPV positive women clearing their infection within 5 years. However, in approximately 10% of women the virus does not clear, and it is the persistence of this HPV infection that represents the greatest risk to women.
Although pap smear screening has resulted in dramatic declines of cervical cancer cases and mortality, the sensitivity of a single cervical cytologic test is quite low. Over the last several years, HPV PCR testing has become commercially available as an adjunctive test. Subsequently, the National Cancer Institute and the American Society for Colposcopy and Cervical Pathology have developed specific evidence-based guidelines incorporating its use, both as a screening tool and as a test to help triage and follow abnormal pap smear and biopsy results. Studies have shown that for certain abnormal pap results, HPV testing significantly improves detection of cervical dysplasia compared to pap smear screening alone, while at the same time reduces the number of unnecessary biopsies.