Wednesday, November 7, 2007
Much discussion recently has focused on a new vaccine that helps protect girls and young women against cervical cancer. The vaccine wards off the virus - the human papillomavirus, or HPV - that causes the disease. This medical breakthrough, however, does not protect against all cancer-causing HPV types and is only FDA-approved for girls and women aged 9-26.
Therefore, it certainly won't help women aged 65 and older, who account for nearly 20 percent of all new cervical cancer cases in the United States and more than 35 percent of all deaths from the disease.
Another technology - a DNA test for HPV - can better protect these women. And now, a proposal before Congress will ensure that older women get access to this test by requiring Medicare to pay for it.
This year, 11,150 women in the United States will be diagnosed with cervical cancer and 3,670 women will die of the disease, according to the American Cancer Society. Many more thousands of women will be treated for high-grade pre-cancerous lesions in their cervixes, undergoing procedures that are uncomfortable, anxiety-producing and expensive.
Widespread screening programs using the pap test have produced significant reductions in cervical cancer rates in the U.S. The pap test helps detect cellular changes caused by HPV infection. The pap test alone, however, is 51 percent to 85 percent accurate, depending upon the type of test used.
An HPV test is approved by the FDA for use, in conjunction with a pap test, in women aged 30 and older. HPV testing identifies women who are infected with "high-risk" types of HPV that could potentially lead to cervical cancer. When used with a pap test in women aged 30 and older, an HPV test increases to nearly 100 percent a clinician's ability to identify women who have the risk factor for cervical cancer and thus require more diligent follow-up as long as the virus persists.
Knowing if a woman aged 65 or older has HPV could help determine if and how often she should continue to be screened. Multiple studies have suggested that incorporating HPV testing into screening programs, per established medical guidelines, improves outcomes while being more cost-effective than those programs without HPV testing.
Ultimately, of course, it is up to clinicians to decide which tests are most appropriate for their patients. But if Medicare covers HPV testing, clinicians will have more options to help prevent older women from developing cervical cancer.
HPV testing is included in cervical cancer screening guidelines from the American College of Obstetricians and Gynecologists, the American Cancer Society, the Association of Reproductive Health Professionals, the American Medical Women's Association and the National Association of Nurse Practitioners in Women's Health. Most private insurance companies and state Medicaid programs already cover HPV testing as part of routine cervical cancer screening for women aged 30 and older.
By requiring Medicare to cover this advanced prevention technique, older women can be assured of access to the same level of healthcare that younger women currently receive. And this can help to better protect all women from cervical cancer.
Susan Scanlan is chair of the National Council of Women's Organizations, a nonpartisan, nonprofit coalition of more than 210 women's organizations across the nation collectively representing more than 11 million women.