Yale Bulletin and Calendar

March 8-22, 1999

Volume 27, Number 24

Yale is first site in state to offer
new test for cervical cancer risk

A new test which helps physicians identify women who are most at risk of having or developing cervical diseases is now available through the School of Medicine's department of pathology, the first site in Connecticut to offer this diagnostic tool.

The HPV (human papillomavirus) DNA test is an FDA-approved laboratory test which detects high-risk HPV infection of the cervix. HPV infection is the most important risk factor for cervical cancer in 95 percent of all cases. Used in conjunction with the Pap test, the HPV test helps in determining the best course of treatment for women with slightly abnormal Pap smears.

In women whose Pap smears contain atypical squamous cells of undetermined significance (ASCUS), a positive HPV test reveals risk of an underlying high-grade (pre-cancerous) lesion and suggests that a biopsy should be obtained for definitive diagnosis. A negative HPV test, on the other hand, provides assurance that the risk of cervical cancer in the immediate future is very low, and eliminates the need for colposcopy, a specialized pelvic exam, and biopsy.

"The HPV test adds new sensitivity and specificity to the Pap," says Janet Brandsma, associate professor of comparative medicine at the School of Medicine. "The two tests work well together. When you do both tests, you have more faith in following a patient conservatively if the result of the HPV test is negative, or alternatively, in determining to move forward with biopsy if the result is positive."

Dr. Peter Schwartz, director of the Gynecologic Oncology Research Program at the Yale Cancer Center, adds that the HPV test "will also have a significant impact on health care costs by eliminating unnecessary diagnostic tests and treatments."

In the near future, the HPV test may even be used prognostically for women with normal Pap tests, since the HPV infection precedes the development of a lesion. Recent research indicates that women with high-risk HPV and normal Pap smears have a 10 percent chance of developing a cervical lesion within two years.

More than 10 million American women are infected with high-risk HPVs, which are transmitted through sexual contact. The majority of cases resolve themselves without treatment, but in some women, the virus causes lesions that can progress to cervical cancer. An estimated 15,000 American women are diagnosed with cervical cancer each year, and nearly one-third of these die from the disease. When detected at an early stage, however, cervical cancer is one of the most successfully treatable cancers.

Yale is conducting a research study of the HPV test to determine its value for women in the Greater New Haven and shoreline areas who have ASCUS Pap smears. Connecticut physicians are eligible to enroll up to 10 ASCUS patients. As part of the study, the HPV Diagnostic Laboratory will perform the HPV test at no cost. Participating physicians must agree to follow HPV-negative patients by a repeat Pap test after six months and to refer all HPV-positive patients on for immediate colposcopy and biopsy. For more information on the study, contact Deborah Blood at 370-4929.

T H I SW E E K ' SS T O R I E S

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U.S. Surgeon General to speak at Medical Library
Yale rower breaks world record (for the fifth time)
A Conversation With a Master of the Web
'From Bojangles to Broadway' exhibit celebrates black musical entertainers
Director will bring his 'unique insights' to 'The Glass Menagerie'
Campus conferences will examine issues related to AIDS
Yale's 'winningest' women's basketball coach stepping down
Yale is first site in state to offer new test for cervical cancer risk
Barbara J. Bachmann, microbiologist and longtime Yale affiliate, died Jan. 31
Campus Notes