For women, more reasons to consider HPV test, while fertility rates decline

HPV2NIHWomen and their doctors may need to give even more consideration to a test for the human papilloma virus (HPV) because research increasingly shows that it detects precancerous cervical changes sooner and better than the long used and widely accepted Pap smear.

The latest findings on the HPV test’s benefits could lead to improvements in women’s reproductive health, even at a time when experts are seeing sharp declines in American female fertility rates and getting more insights into why US women are having fewer babies. And it may lead more experts to urge women to drop “co-testing,”  both the HPV test and the Pap smear.

Researchers in Canada’s British Columbia potentially gave the HPV test one of its more significant boosts with a randomized clinical trial involving more than 19,000 women and following them for four years or so. Their newly published results showed that “there were significantly more cases of precancerous lesions detected early in the trial among the women in the HPV-tested group, compared with the Pap cytology group,” the Washington Post reported. Further, “there were fewer cases of precancer in the HPV test group, compared with the Pap smear group. That’s because cases of worrisome cellular changes already had been detected and dealt with after the women were first screened.”

These findings are key, the newspaper said, because:

The HPV infection is the most common sexually transmitted infection and is usually eliminated by the immune system within a year or two. But when an infection persists, it can cause cellular changes that develop into precancerous lesions and, eventually, malignancies. Almost all cases of cervical cancer are caused by HPV infections. About 13,240 new cases of invasive cervical cancer will be diagnosed in the United States in 2018, according to the American Cancer Society. About 4,200 women will die of the disease.

Experts have watched how tests on HPV and screening for it stack up against the Pap smear, which now, like the HPV test, is a liquid-based cell scrutiny for which materials can be conducted simultaneously. It had been unclear which might be better in cancer detection, so medical scientists had recommended women undergo both, as occurs often now. Many women didn’t realize that they were screened for HPV while getting a pelvic exam.

Doctors have urged women ages 21 to 65 to take the cervical cancer test once every three to five years, though those in the 20s have been told to get the Pap smear only, because HPV is so common the age group and many infections will clear without treatment. As the newspaper reported about the prevalence of HPV:

About 80 million people in the United States are infected with HPV, but most never develop any health problems because most infections go away by themselves, according to the Centers for Disease Control and Prevention. But when infections last longer, they can cause not only cervical cancer but also cancer of the anus and back of the throat, as well as cancer of the penis. That’s why doctors strongly recommend that children and young adults be vaccinated against HPV; a vaccine was approved by the Food and Drug Administration in 2006. Infection with HPV types targeted by the vaccine has declined by nearly two-thirds among teenage girls since HPV vaccination was recommended in the United States, according to a study that also found that there was a decrease in HPV infections among women 20 to 24.

In my practice, I see the harms that patients suffer while seeking medical services, and their struggles to determine the kind and extent of appropriate medical tests, especially for scary conditions like cancer. Over-screening and excessive care adds billions of dollars in waste to the US health care system. Over-testing can trigger unnecessary, invasive, painful, and costly follow-up care. Patients, and, frankly, their doctors and hospitals, may grapple with confusing information about rapidly developing procedures to detect and treat complex conditions.

So, it’s good to see solid research, such as the clinical study on the HPV test, from organizations like the Canadian Institute of Health Research in BC. Its information surely will be carefully considered by influential American groups like the US Preventive Services Task Force (USPSTF), the independent, blue-ribbon group that scrutinizes the best information on protective procedures and advises the public about them. USPSTF has recommended co-testing, though it is updating that advisory now. The federal Centers for Disease Control and Prevention recommends wide HPV vaccination, by the way, and parents should not ignore this advice for their youngsters.

New Data on fertility rates

The new information on how women can better safeguard their reproductive health was issued even as researchers are learning more about why fewer of them are having babies, affecting the nation’s fertility rate, which the New York Times reported “subtly shapes many major issues of the day — including immigration, education, housing, the labor supply, the social safety net and support for working families.”

A new survey by the news organization with the polling group Morning Consult found that the top reasons young adults, notably women, are foregoing children because they want more leisure time and personal freedom, don’t have suitable partners yet, and can’t afford child-care costs.

Time and money, more specifically financial security, weigh heavy on potential parents, and with women gaining greater equality and choice in their lives, they’re postponing or skipping one of life’s major responsibilities in child-rearing, the survey found.

This is occurring at different ends of the economic spectrum, too: Women and men who struggle to make ends meet see formidable obstacles and reasons (high costs and their low wages) for not wanting kids, while their high-earning and “successful” counterparts also have issues. Their go-go careers may put out of whack their work-life balance.

Separately, another New York Times story examined egg freezing as women’s option for postponed procreation. The story reported that, contrary to some contentions, women don’t pursue this path to advance careers but because of relationship concerns and problems. The newspaper told of a soon-to-be-published study of Bay Area women who chose egg freezing and why:

Of the participating women, 85 percent were single, and most were heterosexual. For about half of these single women, it was uncertainty about when they would meet a man to build a family with that brought them to the clinic, they told the researchers. The next largest group was driven there by a divorce or breakup. (Egg freezing was actually covered by several of these women’s divorce settlements.) This was followed by a smaller group of women who were deployed overseas and felt it was wise to freeze their eggs first and then a handful of women who were preparing to have a baby on their own. Career planning was the least common reason. Among the 15 percent of the subjects who were in relationships, the reasons for freezing their eggs were not unlike the single women’s: though they had a partner, he was not yet ready or not interested in building a family.

Earlier, the Washington Post reported on another study of hundreds of affluent, high-achieving Bay Area women who underwent this procedure. The paper said that startling numbers of them had unrealistic expectations of the success rate of frozen eggs resulting in pregnancies. Many were disappointed if the procedure failed to harvest healthy needed numbers of eggs. And half had regrets about egg freezing, perhaps as much because the procedure forced them to consider their relationships.

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