HPV test in SUS can anticipate diagnosis by up to 10 years

The Ministry of Health announced this week the incorporation into the Unified Health System (SUS) of a test for detecting HPV in women classified by the Ministry itself as innovative. The technology uses molecular testing to detect the virus and screen for cervical cancer. Professor and researcher at the State University of Campinas (Unicamp), gynecologist Júlio César Teixeira has been conducting, for almost seven years, an HPV screening program that uses the test that will now be made available on the public network.

In an interview with Agência Brasil, the doctor confirmed the innovative nature of the test and explained that the proposal is for it to replace the exam popularly known as the Pap smear.

“It is a test carried out by a machine, that is, it has an error close to zero, while the Pap smear has many stages where there is a lot of human interference”.

Also according to the gynecologist, the technology allows testing to be carried out only every five years, while HPV screening through the Pap smear must be carried out every three years.

Teixeira also detailed the relationship between HPV infection and some types of cancer that go beyond cervical cancer, such as cancer of the mouth, vulva, penis and anal canal. For the specialist, HPV testing, combined with early vaccination in adolescents up to 15 years old, could change the public health scenario in the country.

Currently, 16 women die from cervical cancer in Brazil – one every 82 minutes, with an average age of 45 years. “This could be avoided. That’s our focus.”

Check out the main excerpts from the interview:

Brazil Agency: This Friday (8), the Ministry of Health announced the incorporation of a test to detect HPV into the SUS. What do you have to say about this new testing in the country?

Júlio César Teixeira: The test itself is truly innovative in the sense that it ends up detecting more pre-cancer lesions than the old Pap smear. So, you end up not missing women who have injuries and you anticipate diagnoses by up to 10 years. It is a test carried out by a machine, that is, it has an error close to zero, while the Pap smear has many stages where there is a lot of human interference and, therefore, ends up being a little more difficult.

This difficulty in Pap smears means that it must be done every three years during routine appointments. The HPV test, as it is more efficient, is carried out every five years. When it is negative, the woman can be 100% calm for five years.

Brazil Agency: This test was already being used in Brazil in the private network and is now being incorporated into the public network?

Teixeira: Yes, it has been around for a few years. It is available in the private network, but not all health plans cover it to this day. People who have access use it because it has a facility and an advantage: initially, it is more expensive than the Pap smear, but, in fact, it ends up being worth it because you end up preventing more and, in those women who would have lesions, you detect it at an earlier stage. very Initial, that is, with much cheaper treatment.

In the end, when you manage a plan or program, it ends up being more economical than what is already spent on the Pap smear.

Brazil Agency: From the point of view of treatment and the possibility of a cure, what is the difference between detecting an HPV lesion at an early stage and another at a more advanced stage?

Teixeira: The Pap smear also detects lesions at the beginning, but, proportionally, the number of cases detected is smaller. So, we are talking about the number of cases, that is, about not missing a woman who has a significant injury, which may not be detected and which will only be detected in three years. With the HPV test, this tends not to happen. And the less serious the injury, the easier it is to heal without treatment.

Sometimes, we just follow up and, when there is an injury that needs treatment, the treatments are the same. The difference is that the HPV test actually anticipates this diagnosis.

We have been using this technology in the SUS of Indaiatuba since 2017. We are now in the sixth year of this program and we have identified that, when we do it, with high coverage, in women in Indaiatuba, we increase the detection of cancers that would appear in the next 10 years in the city and we brought these cancers to the microscopic stage, that is, with easier treatments and closer to 100% cure. That’s the advantage of testing.

Comparing test by test, it has these specific advantages. But it will only work if it is included in an organized program, where you have control over the population that is taking prevention tests and, mainly, those who are not taking it, to call and do it.

Brazil Agency: Do you believe that, with this incorporation of technology, we can think about retiring the Pap smear? Or does it continue as a preventative method for other diseases?

Teixeira: The Pap smear will be replaced by the HPV test as the first approach, as a first test. It will be for each other, yes. That’s how it’s done. It’s really a replacement. However, in 10% of cases, some type of HPV will be detected, which is not so serious, but also not so mild.

In these cases, we perform the Pap test on the same material already collected. So, the Pap test will be used, with another, slightly more modern technology, but on the same material already collected, in 10% of cases.

In other words, one out of every 10 women who will take the HPV test will report an intermediate situation and then a Pap smear will be done to provide more information and indicate the best way to manage this case.

Brazil Agency: Speaking specifically about HPV, we used to know it as a type of sexually transmitted disease (STD) and today it is classified as a sexually transmitted infection (STI)?

Teixeira: That’s right, but it’s just a nomenclature. Of all people, men and women, 80% will have contact with one of the HPV types by the end of their lives. There are several types, there are about 25 that affect the genital region and some of them are related to cancer. So what happens? Almost everyone will have it. Eighty percent is a high number. Yes, there will be contact, there will be this STI. However, the vast majority, 90%, eliminate the virus within 24 months, through the person’s immune response.

Most people have a transient infection and will clear up. The problem is that infection that persists for years, without giving symptoms. Then, injuries start to appear on the cervix, for example, but it can also occur on the anal canal, on the vulva, on the penis, in the mouth. There are several places where pre-cancerous lesions can occur. The cervix is ​​the main one. Basically, that is the main focus because there are many cases and the proportion of cervical cancer caused by HPV is 99.9%, that is, there is practically no cancer in the cervix if there is no HPV. This is where early vaccination comes in.

If we vaccinate the entire population under 15 years of age, this cancer will disappear. However, until this happens, because it would take 20 to 30 years after vaccination in this age group for this to happen, we continue carrying out these periodic preventive tracking programs. Because it has a long transition.

Brazil Agency: Is it important to highlight that you need to vaccinate not only the girl but the boy as well?

Teixeira: Everyone. Because you have cancer caused by HPV in other parts of the body and you have to block the circulation of the virus in the population. We must vaccinate everyone under 15 years of age and this is available in the public system for free. This vaccine currently has two doses, with an interval of six months for this age group, under 15 years old.

In several countries that started vaccinating 10 years before Brazil, there are no more cases and they are already using a single dose of vaccine. In other words, you will reduce until everything is limited, cancer, pre-cancer lesions, the need for one more dose of vaccine. The cancer will disappear and we will be able to invest the money saved and the lives saved in other actions for the country.

Brazil Agency: This vaccine, at the time of its launch in Brazil, generated some controversy. Today, we still see resistance from parents in immunizing their children. What do you have to say about this?

Teixeira: Almost everyone will have this contact with the virus during their lifetime. So, we have to take precautions. There’s no way you can avoid it. But look closely:

The purpose of vaccination is not to prevent a sexual infection or to release a teenager to begin their sexual life. The goal is to prevent cancer. It is a vaccine that prevents cancer. I’m from Unicamp and I’m treating hospitalized people, women aged 30 to 35, with advanced cancer, at a very advanced stage and very bad, who are about to die. We see this every week. And it could be avoided with these vaccination and periodic tracking actions.

Look at an important parallel: hepatitis B causes liver cancer and people acquire the virus through sexual intercourse and blood transfusions. In vaccination against hepatitis B, the child, when born, already has the first dose administered in the maternity ward since 2004 in Brazil. As a result, we are no longer experiencing liver cancer related to hepatitis B in groups under 20 years of age in Brazil. Because everyone is vaccinated.

And no one says anything about it being a virus that can be caught through sexual intercourse. So, what is needed is guidance, public education and awareness.

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