Guest: Jeff Andrews, MD
Presenter: Neal Howard
Guest Bio: Jeff Andrews, MD, FRCSC is the Worldwide Medical Director for Women’s Health and Cancer, BD Life Sciences. A Board-Certified Obstetrician & Gynecologist, he’s provided women with healthcare in community settings in both metropolitan Toronto, Ontario, Canada and Washington DC, and as Associate Professor in academic Duke University Medical Center and Vanderbilt University Medical Center.
Segment Overview: Dr. Jeff Andrews discusses the latest research related to HPV and also highlights a new HPV test that was just approved. This new test detects 14 different types of high-risk human papillomavirus (HPV) and provides genotyping information for types 16, 18 and 45 – which are associated with over 70 percent of cervical cancers worldwide.
Neal Howard: I’m your host Neal Howard. Thank you for joining us here on Health Professional Radio. So glad that you could take the time. Our guest is Dr. Jeff Andrews. He’s joining us on the program to talk about the latest research related to HPV and also to highlight some new tests that have just become recently approved. Welcome to Health Professional Radio Dr. Jeff Andrews.
Dr. Jeff Andrews: Thank you. It’s good to be here.
N: Alright. A bit of background about yourself.
A: I am an obstetrician gynecologist for over 30 years. I worked at Duke University and Vanderbilt University in academic medicine and I’m currently the worldwide Medical Director for Women’s Health and Cancer at BD which develops diagnostic tests.
N: Now we’re talking about HPV or human papillomavirus. Our listeners are mainly healthcare professionals but explain to us what HPV or human papillomavirus is and why it is so important especially when we’re talking about women being at risk of cervical cancer?
A: Good. There are hundreds of strains of this virus or what we call a “genotype”. Some of them cause common warts, some of them cause venereal warts and some of the genotypes ar responsible for cancers, cervical cancer as well as vaginal vulvar, penile, oral and throat cancer. And we’re particularly interested in 14 of these high-risk genotypes that are the ones most likely to cause cervical cancer and there’s been quite an advance in terms of both vaccination and testing for HPV in order to prevent cervical cancer.
N: Now when it comes to being at risk, what are the numbers? How many women or young men as well, are at risk of contracting cancer via HPV?
A: For cervical cancer for women in the U.S., we have about 13,000 new cases of cervical cancer a year and about 4,000 deaths from that. Exposure to HPV is very common. It’s estimated that both men and women in their mid-20s probably have a 60-70% probability of having been exposed to HPV. Usually the HPV infection is cleared by the person’s own immune system and it’s only that people who have persistence of the particular high-risk strain that end up being at risk for progressive changes that can lead to cancer.
N: What would you say is the most significant thing that we should be aware of other than some of the very important factors that you just mentioned?
A: Well primary prevention is vaccination. So it’s most important that all 11 to 12 year old girls and boys receive the vaccination because if that were to happen, we would have dramatic reduction in all those cancers several years later as they all became older. In the meantime while we’re waiting for that benefit, we have secondary prevention which for many years was that was the Pap test looking under the microscope but more recently, that’s been surpassed by the HPV test or a combination of the HPV test. So it’s very important to be screened. Of those cases that I mentioned, the 13,000 cases a year more than half are in women who have been under screened or never had a screening test. So we really need to reach the people who haven’t been screened at all.
N: Now this recently approved product that we’re talking about, this BD Onclarity, talk about this this assay and why it’s so important for women?
A: This assay targets the parts of the HPV virus that are causing the changes in cells. It’s a very large trial over 33,000 women, the results were very positive, indicating that this test is useful in all of the paradigms meaning after an abnormal pap test, the HPV test can be used or before or in combination with which is called “Cotesting” and this particular assay has accurate detection for each of the 14 genotypes and is currently reporting 3 of them individually known as 16, 18 and 45.
N: Is there anything else that makes this new product significantly different from what’s already out there?
A: It’s part of a package, a total package using a surepath liquid based cytology vial which can then be processed for both the cytology and HPV test all through an automated system and so that’s an important aspect as well.
N: What about the ever-changing guidelines for cervical cancer screening? How are those guidelines going to be affected and how is Onclarity going to be affected by those guidelines?
A: So you’re right. There’s four different U.S. screening guidelines currently and one group, the U.S. Preventive Services Task Force is in the process of changing theirs. There’s only one guideline for managing, in other words after you’ve decided to screen what do you do with the abnormal results, that’s from the American Society for Colposcopy and Cervical Pathology and they are just now beginning the next update of their guidelines. This new test works with all of the guidelines that are currently in place and we anticipate the next version of the guidelines will also be harmonious with our test capabilities overall.
N: Talk about I guess the tailored screening that can be afforded using this recently approved assay. Is that something that’s very important or is it simply more tailored than it already has been?
A: Although there are 14 high-risk genotypes, they vary in the risk that they pose, so 16 being the worst. So the kind of detailed information you can get from genotyping is helpful. Also, patients are commonly followed up after an abnormal test or after a colposcopy exam and by using the same test and determining if the same genotype is persistent, you can get additional, a tailored information about the woman’s specific risk. And the whole trend now in in this cancer screening and other cancer screenings is to go to risk based decision making, so the information you get from a test like Onclarity that tells you the specific information you need to know about individual risk.
N: Is this something that is readily available as far as insurance coverage and things of that nature as far as you know?
A: It’s definitely available and it’s definitely covered by commercial insurance. Commercial insurance covers the vaccine and the Pap test, the cytology test and the HPV test.
N: We’d like to learn some more online, where can we go in and learn some more about BD Onclarity and about HPV in general?
A: Our main website is www.bd.com. I just wanted to add something to the last point I mean because you mentioned insurance. As we know, there are people in the United States who don’t have insurance and I’d recommend they reach out to their local public health departments because almost every state in the United States has a program for breast and cervical cancer screening that funds particularly those tests even for people who don’t have Medicaid.
N: Great. Well, I appreciate that and once again, that website?
N: Great. Dr. Andrew, it’s been a pleasure. I’m hoping you’ll come back and speak with us again.
A: Neal, that would be my pleasure. It’s been great talking to you.
A: You’ve been listening to Health Professional Radio. I’m your host Neal Howard. Transcripts and the audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm. You can subscribe to this podcast on iTunes, listen in and download at SoundCloud and be sure to visit our affiliates page at healthprofessionalradio.com.au and also at hpr.fm.