HPV testing affirmed as effective tool to screen for cervical cancer
The value of human papillomavirus (HPV) testing as an additional tool to screen for cervical cancer—joining the traditional Pap smear—has been affirmed by a new meta-analysis and an expert panel’s recommendation based on that analysis, as explained in a set of articles today in the Journal of the American Medical Association (JAMA).
The US Preventive Services Task Force (USPSTF) used the meta-analysis results in revising its recommendation on cervical cancer screening to include a larger role for testing for high-risk HPV strains. HPV causes about 90% of cervical cancer cases.
The task force’s new “A” recommendation for women ages 30 to 65 years lists primary high-risk HPV testing alone as an option, along with the previous recommendation of either high-risk HPV and Pap smear (cytology) together (“cotesting”) every 5 years or continued cytology every 3 years. Cytology every 3 years remains the recommended way to screen women 21 to 29 years old.
The meta-analysis, led by Joy Melnikow, MD, MPH, of the University of California, Davis, included eight randomized controlled trials, five cohort studies, and one individual-participant-data meta-analysis.
The researchers found that high-risk HPV testing alone led to a significant increase in detection of severely abnormal cervical cells (CIN [cervical intraepithelial neoplasia] 3+), compared with cytology alone, in the first round of screening. Co-testing did not yield a significant increase in detection of CIN3+, compared with cytology alone.
The analysis also indicated, however, that both HPV alone and co-testing produced more false-positive results and higher follow-up colposcopy rates than cytology alone, “which could lead to more treatments with potential harms,” the report states.
"We found that regular screening with any method will lead to lower cervical cancer rates," Melnikow said in a UC-Davis press release. "In the US, where most women are not part of an organized screening program, our biggest challenge is reaching women who have not been screened."
Aug 21 JAMA articles: meta-analysis, USPSTF statement, related commentary
Aug 21 UC-Davis press release
H7N9 avian flu viruses brought into Japan via illegal raw poultry
Raw poultry brought illegally into Japan by airline passengers contained highly pathogenic and low-pathogenic H7N9 avian flu viruses, according to a study published yesterday in Virology.
This is the first report detailing the isolation of H7N9 from raw meat products outside mainland China and suggests that the illegal transport of poultry is a possible cause of the spread of the virus in Asia, the authors wrote.
The researchers tested confiscated poultry meat from travelers coming to Japan from May 2016 to January 2018. Dogs at customs stations detected the poultry, which included ducks, quail, and chickens. A total of 162 specimens were collected.
Three H7N9 and three H9N2 subtypes were isolated from meat- and organ-pooled samples of chicken (Gallus gallus) or Muscovy duck (Cairina moschata) meat products brought by passengers from China and Vietnam, the authors found.
H7N9 avian influenza viruses were first detected in China in 2013, and have since become a global threat. Though infrequently transmitted to humans, the virus can be deadly to people who come into close contact with infected birds and have caused at least 1,625 human cases and 623 deaths since 2013, according to statistics from the United Nations Food and Agriculture Organization.
"To prevent passengers carrying infectious [avian flu viruses] via contaminated products, it is important to increase publicity and awareness to ensure that passengers, particularly from areas where the virus is prevalent, comply with import regulations," the authors concluded.
Aug 20 Virology study