Endometrial cancer is the second most common malignancy. Routine Papanicolaou (Pap) testing has dramatically reduced the death rate of cervical cancer since its implementation in the 1950s. Over 1500 women each year in Canada have cervical cancer diagnosed and 430 deaths annually are due to this malignancy.  Cervical cancer should be 90% curable.

It is now recognized that a genital virus infection with Human Papillomavirus (HPV) may cause a pre-cancerous change in women.  in the cells of the cervix.  The HPV infection has no symptoms and is not detected by either doctors or patients.  The pre-pcancerous changes (called cervical intraepithelial neoplasia or CIN) may then alter further into invasive cervical cancer.

One of the problems with routine Pap testing is the discovery of an abnormality described as “atypical squamous cells of undertermined significance” also called ASCUS.  Most of these cases resolve without treatment but cause considerable anxiety in patients who must be checked frequently without a clear diagnosis. This is where HPV testing will play an important role.

It turns out that women with ASCUS who also have a negative HPV test are at very low risk for cancer and can be monitored in the routine way.

But women with ASCUS who have a positive HPV test should be referred for colposcopy (a direct visualization and biopsy procedure).

This strategy will identify 96% of women with cervical cancer, compared with 85% when a second Pap smear is used.

The role of HPV testing in BC has not yet been clarified but the assay is now available through MDS using the Digene Hybrid Capture Assay that relies on DNA analysis of the HPV.