UC Davis experts: Cervical cancer screening issues

The following UC Davis faculty are available to discuss issues related to cancer treatment at the UC Davis Cancer Center. To interview any of these experts, please contact Karen Finney, UC Davis Cancer Center, phone (916) 734-9023, pager (916) 762-7787, karen.finney@ucdmc.ucdavis.edu.

• HPV testing: Cost-effective at what cost?
• HPV testing is cost-effective
• Women’s preferences in cervical cancer screening and follow-up
• Ethnic disparities in cervical cancer
• Role of HPV and HPV testing

HPV testing: cost effective at what cost?

An estimated 55 million Pap tests are performed in the United States each year. If every woman in the United States with an equivocal or borderline Pap result received a follow-up HPV test to screen for cervical cancer, the tab would be an estimated $250 million a year, Joy Melnikow argues in an editorial in the Jan. 18, 2006, issue of the Journal of the National Cancer Institute. Melnikow, a professor of family and community medicine at UC Davis School of Medicine and Medical Center, says that before policies are made for widespread adoption of new technologies like HPV testing, use of the same resources for other programs should be considered. She argues that a greater impact could be made on cervical cancer if resources were used to screen women who are not getting regular Pap tests due to cultural, language, financial or other barriers.

HPV testing is cost-effective

HPV testing is the most cost-efficient follow-up strategy for women with certain abnormal Pap findings, such as Paps with equivocal or borderline results, counters Lydia P. Howell, a professor of pathology and associate dean of the UC Davis School of Medicine. Howell notes that HPV testing can often be done on cells collected during the Pap test, in many cases reducing the number of follow-up doctor visits required. Fewer doctor visits translate to less time lost from work, less need for childcare for women to get to the visits and better patient compliance. Howell, who participated in a national consensus conference that recommended HPV testing for equivocal Pap tests, believes such factors should be included in cost-effectiveness analyses. Nationally recognized for her contributions to women's health, Howell is working to improve protocols for prevention, diagnosis and treatment of cervical cancer, and to increase access to gynecological care for low-income women.

Women’s preferences in cervical cancer screening and follow-up

The best screening methods are the ones that patients will use. Joy Melnikow, a professor of family and community medicine at UC Davis School of Medicine and Medical Center, conducts research to better understand women’s health-care preferences and how women make health-care decisions. She has led investigations into the natural history and treatment outcomes of cervical dysplasia, and carried out studies of women’s preferences for the management of minor abnormalities detected by Pap testing. She is the principal investigator of an ongoing study to assess the cost-effectiveness of alternative surveillance strategies for women who have been treated following an abnormal Pap test.

Ethnic disparities in cervical cancer

Since the Pap test was introduced more than 50 years ago, deaths from cervical cancer in the United States have dropped by 75 percent. But cultural, language and economic barriers prevent many women in this country from getting Pap tests. Moon S. Chen Jr., a professor of public health sciences at UC Davis and associate director for cancer disparities and research at UC Davis Cancer Center, can talk about ethnic disparities in cervical cancer incidence and mortality, the causes of these disparities and what is being done nationally to reduce them. For example, Vietnamese women have the highest incidence of cervical cancer in the U.S., while blacks have the highest death rate from the disease. Chen, appointed by President Bush to the National Cancer Advisory Board in 2002, is one of the nation’s foremost experts on ethnic disparities in cancer, particularly among Asian Americans.

Role of HPV and HPV testing

Human papillomavirus is the name of a group of viruses that infect the outer layer of the skin and genital tract. About 30 strains are sexually transmitted and cause genital HPV-related problems such as warts; some of these strains are linked to cervical cancer. Lloyd Smith, professor and chair of obstetrics and gynecology at UC Davis, works on developing HPV vaccines. Gary Leiserowitz, chief of gynecologic oncology at UC Davis Cancer Center, has done research on the immunology of HPV infection. Smith and Leiserowitz can discuss HPV strains and risks and the potential impact of an HPV vaccine on cervical cancer. They can also talk about the role of HPV testing in the prevention and diagnosis of cervical cancer, including concerns about cost-effectiveness. Leiserowitz argues that HPV testing is the most effective follow-up strategy for women with equivocal Pap results.

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