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PaperChase Super Duper Deep Dive - HPV

Andrew Buelt, DO and Joe Weatherly, DO
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No me gusta!

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In this Paperchase Super Duper Deep Dive, Joe and Andrew do an exhaustive literature search and conclude that HPV testing ALONE is all we need to be doing for cervical cancer screening.


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Valerie E., MD -

I listened to this yesterday, and I kept waiting for you to address the question of HPV screening in the age <30 group. Current guidelines discourage HPV screening in this age group due to the high prevalence of HPV, most of which will regress spontaneously. I could not tell from your Deep Dive how HPV screening alone would be implemented in this age group. You did not address if we should screen women age 21-30 with HPV testing alone. If so, won't we end up doing a LOT more colpos and more invasive procedures? I look forward to the clarification.
Val Edwards MD
Family Physician, Sitka AK

Heidi J., MD -

Hi Valerie -
We could do a whole episode on HPV screening and still not be done with it! The different guidances for various age groups do muddy the waters. I passed along your question to Andrew and Joe and here is their reply. Thanks for listening and taking the time to write in.

Hey Valerie-

According to the guidance "Primary hrHPV screening should not be initiated prior to 25 years of age" This is based on the ATHENA trial in which "Primary hrHPV screening with genotyping for HPV 16 and 18 and re- flex cytology for women with the 12 other hrHPV genotypes, starting at 25 years of age, doubled the number of colposcopies but resulted in a 54% greater detection of CIN3+ when compared to the same strategy starting at 30 years of age". The guidance does state the panel was concerned about the increase number of colposcopies despite increase detection of disease. The transition from current guidelins for 21-24yr olds requires care and they state ". According to current guidelines, if a woman initiates screening at 21 years of age and is re-screened at age 24 years, the next time she would require screening would be at age 27. Primary hrHPV screening should begin 3 years after the last negative cytology and should not be performed only one or two years after a negative cytology result at 23 to 24 years of age."

Hope this helps,
Andrew and Joe

Amy S. -

Hi Team!

I loved the Deep Dive on HPV and have a question for you all on self-swab cytology. Namely, what specific instructions do you give the patient and which swab(s) do you use? I'd be interested in using this for patients who have vaginismus or can't tolerate pelvic exams. Thanks:)

Amy Stulman, NP - One Medical

Heidi J., MD -

Hey Amy :) I've passed your comment along to Andrew and Joe and we'll keep you apprised!

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