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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.



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. 


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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6 Exercise safety tips

Now, as social restrictions ease, you may find yourself stepping up your workouts, whether you’re training for an event or working to improve your game in a recreational league.



In the wake of the COVID-19 pandemic, many Americans are more aware of their health and wellness. Now, as social restrictions ease, you may find yourself stepping up your workouts, whether you’re training for an event or working to improve your game in a recreational league.

Sprains, strains and injuries can happen to even the most seasoned athletes. When you’re testing your limits, even a minor injury can alter your performance. Consider products and supports like these from the CURAD Performance Series product line, available at Walmart and Amazon, to help you get back in the game quickly and safely.

Find more resources to support your fitness journey at

Keep Dirt and Germs Away

The more active you are, the harder it can be to find a bandage that stays with you all day or all game long.

Spray Away Sore Spots

Controlling mild pain can help keep you at the top of your game, and a topical analgesic works fast to heal common pain brought on by fitness and exercise, such as pain in knees, feet, shoulders and backs.

Put Pain in the Past

When recovery becomes the name of the game and pain relief is needed after daily workouts or bodily injuries. Cold packs work to heal bruises, reduce swelling and relieve headaches and general pain points while microwavable heat packs provide satisfying heat therapy to address sore and stiff joints, muscle cramps and tension.

Reduce Impact of Knee Strain

Weak, injured or arthritic knees can come from many sources, including tendonitis and a wide range of conditions that result in strain or overuse. An adjustable band can provide support for on-field sports and during workouts or everyday activities.

Manage Pain and Relieve Pressure

If you participate in endurance and strength exercises or certain sports, you may ask a lot of your joints. Kinesiology tape can be configured a multitude of ways to help reduce pain and improve blood circulation, as well as relieve tension and pressure.

Control Back Strain

When your back is strained, your body and performance can suffer. A mild or moderate sprain can benefit from strong support and compression.

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Exercise can provide relief for dry, itchy eyes

A significant increase in tear secretion and tear film stability after participating in aerobic exercise can be another remedy for relieving dry, itchy eyes.



Photo by Quinten de Graaf from

A team led by researchers from the University of Waterloo discovered that a significant increase in tear secretion and tear film stability after participating in aerobic exercise can be another remedy for relieving dry, itchy eyes. 

Every time we blink, our eyes are covered in tear film—an essential protective coating necessary for maintaining healthy ocular function. Healthy tear film comprises three layers–oil, water, and mucin–that work together to hydrate the ocular surface and protect against infection-causing irritants like dust or dirt.

When any part of the tear film becomes unstable, the ocular surface can develop dry spots, causing eye symptoms like itchiness or stinging and burning sensations.

“With so much of our activity tied to screen usage, dry eye symptoms are becoming increasingly common,” said Heinz Otchere, a PhD candidate in vision science at Waterloo. “Instead of having to use eye drops or other alternative treatments, our study aimed to determine if remaining physically active can be an effective preventative measure against dryness.”

Fifty-two participants were divided into two groups—athlete and non-athlete—to participate in an exercise session. Participants in the athlete group exercised at least five times per week, while non-athlete participants exercised no more than once per week. Researchers, which included experts from the University of Cape Coast in Ghana, performed visual examinations before and five minutes after each exercise session, where tear secretion and tear break-up time were assessed.

While participants in the athlete group showed the largest increase, Otchere says all participants experienced a meaningful boost in tear quantity and tear film stability after the exercise session. 

“It can be challenging for people to regularly exercise when the demand is there to work increasingly longer hours in front of screens,” Otchere said. “However, our findings show physical activity can be really important for not just our overall well-being, but for our ocular health too.”

The study, Differential effect of maximal incremental treadmill exercise on tear secretion and tear film stability in athletes and non-athletes, was co-authored by Otchere, the University of Cape Coast’s Samuel Abokyi, Sekyere Nyamaah, and Michael Ntodie, and Ghana’s Our Lady of Grace Hospital’s Yaw Osei Akoto. It was recently published in the Experimental Eye Research journal.

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Late-life exercise shows rejuvenating effects on cellular level

Late-life exercise mitigates skeletal muscle epigenetic aging.



Photo by Caley Vanular from

For people who hate exercising, here comes some more bad news: it may also keep you younger. Not just looking younger, but actually younger, on an epigenetic level. By now, the benefits of exercise have been well established, including increased strength of bones and muscles, improved mobility and endurance, and lower risk of heart disease, diabetes and high blood pressure.

But younger?

A study recently published in Aging Cell, “Late-life exercise mitigates skeletal muscle epigenetic aging,” suggests this could be the case. The paper was written by a team of seven researchers across three institutions, including Kevin Murach, an assistant professor in the Department of Health, Human Performance and Recreation at the U of A. Murach’s grant from the National Institute of Health funded the study, and he was one of three co-first authors.

Bootcamp for Mice

While the paper is dense with data, reflecting the use of several analytic tools, the experiment that generated the data was relatively straightforward. Lab mice nearing the end of their natural lifespan, at 22 months, were allowed access to a weighted exercise wheel. Generally, mice require no coercion to run and will do so voluntarily. Older mice will run anywhere from six to eight kilometers a day, mostly in spurts, while younger mice may run up to 10-12 kilometers. The weighted wheel ensured they built muscle. While there isn’t a direct analogue to most human exercise routines, Murach likened it to “a soldier carrying a heavy backpack many miles.”

When the mice were studied after two months of progressive weighted wheel running, it was determined that they were the epigenetic age of mice eight weeks younger than sedentary mice of the same age — 24 months. Murach noted that while the specific strain of mice and their housing conditions can impact lifespans, “historically, they start dropping off after 24 months at a significant rate.” Needless to say, when your lifespan is measured in months, an extra eight weeks — roughly 10 percent of that lifespan — is a noteworthy gain.

Methylation, My Dear Watson

The science behind this, while complicated, hinges largely on a biological process known as DNA methylation. A recent New York Times article discussing Murach’s work on muscle memory described methylation “as a process in which clusters of atoms, called methyl groups, attach themselves to the outside of genes like minuscule barnacles, making the genes more or less likely to turn on and produce particular proteins.”

As the body ages, there tends to be increased DNA methylation, or even hypermethylation, at promoter sites on genes in muscle. “DNA methylation changes in a lifespan tend to happen in a somewhat systematic fashion,” Murach explained, “to the point you can look at someone’s DNA from a given tissue sample and with a fair degree of accuracy predict their chronological age.” Due to this, researchers can use one of a number of “methylation clocks” to determine the age of a DNA sample.

DNA Methylation, Aging and Exercise

While the paper strengthens the case for exercise, there is still much that needs to be learned. Though the connection between methylation and aging is clear, the connection between methylation and muscle function is less clear. Murach is not yet prepared to say that the reversal of methylation with exercise is causative for improved muscle health. “That’s not what the study was set up to do,” he explained. However, he intends to pursue future studies to determine if “changes in methylation result in altered muscle function.”

“If so, what are the consequences of this?” he continued. “Do changes on these very specific methylation sites have an actual phenotype that emerges from that? Is it what’s causing aging or is it just associated with it? Is it just something that happens in concert with a variety of other things that are happening during the aging process? So that’s what we don’t know.”

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