You've probably seen Digene's new ad for their HPV test with the tagline, "take the test, not the risk." I'm flabbergasted that this commercial hasn't been taken off the air, for it completely misrepresents what the test is meant for. The commercial clearly makes the implication that the life of Jodi, "whose story every woman should hear" was saved because her positive HPV test allowed her doctor to catch her disease before it became cancer. THIS IS COMPLETELY FALSE. A positive test is only useful if your pap smear is equivocal. Otherwise, a negative test along with a normal pap smear can reassure you that your cervix is fine and doesn't need to be checked on again for three years (instead of the standard 1 year). The reason they don't recommend the test for women under 30 is because around 60% of sexually active women in the under 30 age range are positive for a high risk strain of the HPV virus anyway. We want those women to come back yearly for their paps regardless of what Digene says about their HPV status. Jodi's pap was normal, but she was HPV positive. All this means is that she had a normal pap smear and an unnecessary test and would have to come back again the following year for another pap smear - which, apparently, "showed that she had cervical disease." But, if she'd never taken the test, her doctor would have told her to come back in a year for another pap smear ANYWAY. Therefore, Jodi, "whose story every woman should hear" is exactly the person for whom the HPV test is of no value whatsoever!
Take home message = please help do your part to help in not contributing to the high cost of healthcare by not asking your doctor for an unnecessary test unless you are a) over 30 and b) are not engaged in any high risk behavior. Second take home message = please don't engage in any high risk behavior.
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5 Comments
Dr. Logan: Full disclosure -- I work for Qiagen (which now owns Digene). And I am very familiar with Jodi McKinney's story. You are quite correct that the HPV test is not recommended for women under 30, because HPV infections are so common in that age group, but are usually transient. Jodi, however, was well over 30 when she was tested for HPV along with her Pap -- just when the American College of Obstetrics and Gynecology and the American Cancer Society say in their guidelines that routine HPV testing can be used, no matter what the Pap result. Although it is true that when Jodi returned for re-testing, as recommended by the guidelines, her Pap had become abnormal, we have records of many other women whose Paps were still normal even upon re-testing. In fact, the Journal of the National Cancer Institute recently published a report attributing one-third of cervical cancers to Pap detection failure. That's why the FDA has approved the HPV test for routine use, along with the Pap, in women age 30+.
Pam Rasmussen
Sure, the pap smear does not have a 100% sensitivity. But, if it's normal, a positive HPV test doesn't help you. You're not going to do anything differently in an over 30 woman with a negative pap smear an a positive HPV test versus an over 30 woman with a negative pap and no HPV test. The test is only useful in order to space out pap intervals. It doesn't help you "catch" additional cases of cervical cancer.
I am shocked to see a provider make such a statement. Have you not seen the 300 plus journal and clinical white papers? Have you not taken intoconsideration what ASCCP, ACS, NPWH, ACOG, NCI, NIH... have recommended and why? Ignorance is what leads to cervical cancer, the one cancer where we now know the root cause and can truly triage and manage patients accordingly. Before you make such comments, do your homework!!! Here's one link to check out... Others include NEJM, NCI, CDC's site and the list goes on.
http://www.nccc-online.org/resources/screening_prevention/combination_paptest.html
PS-Cytology litigation is huge. So not only is it best for your patients, but best for your protection as well.
Since you don't specify which statement it is that you are "shocked' to hear me make, it's kind of hard to know how to respond. I don't take issue with the HPV test itself or with any of the ACS, ACOG etc. guidelines. What I take issue with is the way in which the HPV test is marketed. None of the above organizations recommend colposcopy for a woman with a normal pap smear, but a postitve HPV test - which is what the Digene commercial would have you believe. The HPV test is useful for spacing out the frequency with which women get pap smears and for triaging ASC-US. Not useful as an extra safety measure for a woman with a normal pap smear.
I agree, this commercial is totally misleading. They make you think - oh my, Jodi would have died. No, she has HPV, like 90% of all the women I know, me included. Great, lets say you know you have HPV, what do you do? Just get a pap yearly... Guess what, if you didn't have the HPV test... you still get it yearly. What is the difference? Oh, I know the difference... more costs out of my pocket right to the HPV manufacturer.
Jodi would not have died, and probably would not have even had cancer. The commercial didn't say did she have a follow up colposcopy? Did she have a LEEP?
I would guess no, since her pap was clear, it was probably wait and see.
Stupid commercial.