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HPV-only screening misses cervical cancers in women over 30

HPV-only screening is less likely to accurately detect cervical pre-cancer and cancer than testing that includes a Pap test in women 30-65 years of age, according to a new study.

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HPV-only screening is less likely to accurately detect cervical pre-cancer and cancer than testing that includes a Pap test in women 30-65 years of age, according to a new study published in Cancer Cytopathology, a peer reviewed journal of the American Cancer Society. The study, by researchers at Quest Diagnostics and the University of Pittsburgh Medical Center (UPMC), reinforces medical guidelines recommending women in this age group be screened with both Pap and HPV tests to rule out cancer risk, but which have come into question following FDA approval of an HPV-only screening test last year. 

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The study is believed to be one of the largest to examine the effectiveness of HPV and Pap screening for cervical pre-cancer and existing cervical cancer, based on approximately 8.6 million women 30-65 years of age who received concurrently performed Pap and HPV tests (co-testing) by Quest Diagnostics laboratories in the United States. Of these, 256,648 women also received a biopsy to detect cancer and 526 had confirmed cases of cervical cancer.

According to the analysis, 18.6% of women with confirmed cervical cancer received a negative test for human papillomavirus (HPV), compared to 12.2% that had a negative Pap test and 5.5% that had a negative co-test result. Of 169 women with confirmed cervical adenocarcinoma, the most difficult form of cervical cancer for which to screen, 26.6% received a negative HPV test, compared to 20.7% that had a negative Pap test and 8.3% that had a negative co-test result.

“Our study arrives at a crucial moment in the evolution in cervical cancer screening for millions of women in the US,” said co-author R. Marshall Austin, M.D., Ph.D., professor of pathology at Magee-Womens Hospital of UPMC. “Our large-scale, real-world patient data provides convincing evidence that HPV-only testing would tragically miss many cervical cancers that would be detected if co-testing were employed. In fact, our study showed that Pap reliably detected more cervical cancers than HPV-only, an incredibly important finding in light of the current debate about the use of HPV-only as a primary cervical cancer screen. Cervical cancer screening has been one of the great success stories in cancer prevention, and we hope that the medical community takes these findings seriously as it considers the best screening approach to promote favorable health outcomes for women.”

Medical guidelines have recommended that women 30-65 years of age be screened periodically for cervical cancer with HPV-Pap co-testing. HPV tests identify the presence of the virus that causes most cervical cancers, while Pap tests identify cellular abnormalities in the cervix caused by HPV infection that could indicate the presence of cancer or precancerous cellular changes. Cervical cancer, particularly when detected in early stages, can typically be treated with a variety of measures.

In April 2014, the FDA approved an indication for the cobas HPV test to be used alone as a primary cervical cancer screen in women 25 years of age and older. The FDA approval was based on a clinical trial that compared HPV testing to Pap testing and involved eight confirmed cervical cancer cases. While the American Congress of Obstetricians & Gynecologists (ACOG) continues to recommend co-testing in women 30-65 years of age, the Society of Gynecologic Oncology and the American Society for Colposcopy and Cervical Pathology issued interim guidance in January 2015 citing HPV-only testing as a viable alternative to Pap-HPV co-testing or Pap alone.

“Cervical cancer was the leading cancer killer of women in the United States before the introduction of the Pap test. Our latest Quest Diagnostics Health Trends study involving one of the largest populations of co-tested women shows that the Pap test should continue to play a front-line role in the battle against cervical cancer,” said Douglas S. Rabin, M.D., medical director, women’s health, Quest Diagnostics.

The investigators analyzed results of HPV tests and Pap tests in samples of women 30-65 years of age for differences in rates of positive and negative tests results in women who were co-tested, tested only by Pap and tested only by HPV. Of the 256,648 women whose de-identified test results were analyzed for the study, 1.6%, or 4,090, had intraepithelial neoplasia stage 3 (CIN3), a premalignant condition, or more severe biopsy results. Proactive management of CIN3 is recommended to minimize the risk of cancer.

Key findings:

  • HPV alone missed more confirmed cancers than Pap alone. Among 526 women with diagnoses of cervical cancer in the study, 18.6% were HPV negative, compared to 12.2% that were Pap-test negative and 5.5% that were co-test negative, an approximately three-fold improvement in the cancer detection rate of co-testing compared to HPV only. In addition, 26.6% of women with cervical adenocarcinomas tested HPV negative.
  • Co-testing identified more cases of CIN3 and more severe results. Co-testing detected 98.8% of women with CIN3 or more severe cervical biopsy results, compared to 94.0% for HPV-only testing and 91.3% for Pap-only testing. Among women who had an abnormal Pap test result, a negative HPV result, and a CIN3 or more severe cervical biopsy result, 35.4% had cervical cancer.
  • Older age associated with HPV-negative test results in women with cervical cancer. The average age of women in the study who had a Pap test was 45.8 years of age. Women with HPV-negative cervical cancer were 52-53 years of age on average compared to 43-44 years of age on average for all HPV-negative patients studied.

The study, “Comparison of cervical cancer screening results among 256,648 women in multiple clinical practices,” is available HERE.

“This study highlights that up to 19%, or about 2,400, of the approximately 12,400 women diagnosed with cervical cancer each year could be falsely reassured of a negative screening result were they screened by HPV-only testing. As early detection and treatment of cervical cancer are critical to a favorable outcome, it is important that the best and most sensitive diagnostic tools for cancer detection be identified and made available to all women. Our data support co-testing in women 30–65 years of age as the most effective screening test for cervical cancer detection,” Dr. Rabin said.

According to the American Cancer Society, nearly 12,400 women are diagnosed with cervical cancer annually, and more than 4,000 will die of the disease. The incidence of cervical cancer deaths has declined dramatically in the United States “due to early detection as a result of screening with the Pap test.” More than half of new cervical cancer cases occur among women who have never or rarely been screened, according to the Centers for Disease Control and Prevention.

The present study’s strengths are its size, national scope and use of unselected patient results rather than a control study as well as the use of quality laboratory methods. The HPV tests in the study may not share the precise performance characteristics as the cobas HPV test and are not intended to be used as HPV-only screens. The study was performed in compliance with applicable privacy regulations and the company’s strict privacy policies, and was determined to be exempt from Western Institutional Review Board.

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Fitness

Study finds moderate-vigorous physical activity is the most efficient at improving fitness

Dedicated exercise (moderate-vigorous physical activity) was the most efficient at improving fitness. Specifically, exercise was three times more efficient than walking alone and more than 14 times more efficient than reducing the time spent sedentary. Additionally, they found that the greater time spent exercising and higher steps/day could partially offset the negative effects of being sedentary in terms of physical fitness.

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In the largest study performed to date to understand the relationship between habitual physical activity and physical fitness, researchers from Boston University School of Medicine (BUSM) have found that higher amount of time spent performing exercise (moderate-vigorous physical activity) and low-moderate level activity (steps) and less time spent sedentary, translated to greater physical fitness.

“By establishing the relationship between different forms of habitual physical activity and detailed fitness measures, we hope that our study will provide important information that can ultimately be used to improve physical fitness and overall health across the life course,” explained corresponding author Matthew Nayor, MD, MPH, assistant professor of medicine at BUSM.

He and his team studied approximately 2,000 participants from the community-based Framingham Heart Study who underwent comprehensive cardiopulmonary exercise tests (CPET) for the “gold standard” measurement of physical fitness. Physical fitness measurements were associated with physical activity data obtained through accelerometers (device that measures frequency and intensity of human movement) that were worn for one week around the time of CPET and approximately eight years earlier.

They found dedicated exercise (moderate-vigorous physical activity) was the most efficient at improving fitness. Specifically, exercise was three times more efficient than walking alone and more than 14 times more efficient than reducing the time spent sedentary. Additionally, they found that the greater time spent exercising and higher steps/day could partially offset the negative effects of being sedentary in terms of physical fitness.

According to the researchers, while the study was focused on the relationship of physical activity and fitness specifically (rather than any health-related outcomes), fitness has a powerful influence on health and is associated with lower risk of cardiovascular disease, diabetes, cancer and premature death. “Therefore, improved understanding of methods to improve fitness would be expected to have broad implications for improved health,” said Nayor, a cardiologist at Boston Medical Center.

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Fitness

Tips to avoid common running injuries

Injuries are very common among runners. Recent research estimates that 82% of runners will become injured during their running career and up to 90% will experience injury while training for a marathon. Some of the most common include a stress fracture, plantar fasciitis, hamstring tendinitis, ankle sprain, runners’ knee, and Achilles’ tendonitis.

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Photo by Malik Skydsgaard from Unsplash.com

Whether training for a marathon or preparing for your first community race, being knocked off course with pain can be hard to handle mentally and physically.

Injuries are very common among runners. Recent research estimates that 82% of runners will become injured during their running career and up to 90% will experience injury while training for a marathon. Some of the most common include a stress fracture, plantar fasciitis, hamstring tendinitis, ankle sprain, runners’ knee, and Achilles’ tendonitis.

Injury prevention is critical. Here are some safety tips from Dr. Joshua Blomgren, a 15-time Chicago Marathon team physician and sports medicine physician, Midwest Orthopaedics at Rush:

Don’t over-train

Don’t increase weekly mileage or intensity by more than 10 percent each week. Build up slowly and let a good training schedule determine how much you run.

Invest in good shoes

Go to a specialty running shop to be properly fitted for running shoes and/or orthotics. Replace them every 350-500 miles. Incorrect shoes can affect your gait, leading to injuries in your feet, legs, knees, or hips.

Choose the best running surface

Look for running surfaces that absorb shock. Opt for asphalt over concrete. Find grass or dirt trails, especially for higher mileage. Avoid uneven surfaces and seek paths with slow curves.

Stretch!

Training causes tight muscles, leading to strain and changes in your gait. Commit to a stretching program. Just 5 -10 minutes after each workout can make a big difference.

Strengthen muscles

Runners have tight hip flexors because their quads are overtrained. Strengthen your hamstrings and glutes to reduce chance of injury and abductors, adductors, and core to create stability.

Watch out for heel striking

Heel striking occurs when your feet land in front of you and your heel hits the ground first. This is common among new runners but can lead to injuries such as shin splints, stress fractures, and joint pain. Land mid-sole with your foot directly underneath your body.

Prioritize posture

Good form means staying upright and keeping your shoulders back and relaxed. Work core exercises into your training and do posture checks every so often. Hold your head right above your shoulders and hips.

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Fitness

Postmenopausal women can dance their way to better health

After menopause, women are more likely to experience weight gain, overall/central body adiposity increases, and metabolic disturbances, such as increases in triglycerides and bad cholesterol. Together, these changes ultimately increase cardiovascular risk. Around this same time, women often are less physically active, which translates into reductions in lean mass and an increased risk of falls and fractures.

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Photo by Olivia Bauso from Unsplash.com

Women often struggle with managing their weight and other health risk factors, such as high cholesterol, once they transition through menopause. A new study suggests that dancing may effectively lower cholesterol levels, improve fitness and body composition and in the process, improve self-esteem. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

After menopause, women are more likely to experience weight gain, overall/central body adiposity increases, and metabolic disturbances, such as increases in triglycerides and bad cholesterol. Together, these changes ultimately increase cardiovascular risk. Around this same time, women often are less physically active, which translates into reductions in lean mass and an increased risk of falls and fractures. As a result of all these changes, postmenopausal women often suffer from decreased self-image and self-esteem, which are directly related to overall mental health.

Physical activity has been shown to minimize some of the many health problems associated with menopause. The effect of dancing, specifically, has already been investigated with regard to how it improves body composition and functional fitness. Few studies, however, have investigated the effects of dance on body image, self-esteem, and physical fitness together in postmenopausal women.

This new study was designed to analyze the effects of dance practice on body composition, metabolic profile, functional fitness, and self-image/self-esteem in postmenopausal women. Although the sample size was small, the study suggested some credible benefits of a three-times-weekly dance regimen in improving not only the lipid profile and functional fitness of postmenopausal women but also self-image and self-esteem.

Dance therapy is seen as an attractive option because it is a pleasant activity with low associated costs and low risk of injury for its practitioners. Additional confirmed benefits of regular dancing include improvement in balance, postural control, gait, strength, and overall physical performance. All of these benefits may contribute to a woman’s ability to maintain an independent, high-quality lifestyle throughout her lifespan.

Study results are published in the article “Dance practice modifies functional fitness, lipid profile, and self-image in postmenopausal women.”

“This study highlights the feasibility of a simple intervention, such as a dance class three times weekly, for improving not only fitness and metabolic profile but also self-image and self-esteem in postmenopausal women. In addition to these benefits, women also probably enjoyed a sense of camaraderie from the shared experience of learning something new,” says Dr. Stephanie Faubion, NAMS medical director.

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