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  • incas58 incas58 Mar 5, 2008 11:14 PM Flag

    Screening

    for anyone who has difficulty understanding scientific articles here is a reporter who summarizes the JNCI Goldie study in plain english:

    http://www.medscape.com/viewarticle/570970

    <<The team suggests a change in strategy for both vaccinated and unvaccinated women. Currently, the guidelines recommend screening with cytology methods and using HPV DNA testing only when the results are equivocal. Dr. Goldie and colleagues suggest that it would be more cost-effective to continue screening using cervical cytology with HPV triage for women between the ages of 21 and 25 years, and then to switch to HPV DNA testing with cytology triage for women older than 30 years.>>

    for definitional purposes current recs refer to hpv WITH cytolgy as co-testing...when primary is referred to it means the primary or first test, triaging to the secondary test...so cytology reflex to hpv for abnormals is primary cytologic screening, whereas hpv primary triage to cytology is primary hpv screening

    on another note, just released is the new eurogin roadmap out of the 2007 conference specifically dealing with the vaccine era and are not to be construed as recommendations, just where they think things are going...nice description of the changes that might take place with regards to test performance in a vaccine era but also make supportive statements of hpv reflex to cytology in unvaccinated women...the franco/cuzick article (at the end) deals with the screening implications:

    http://www.eurogin.com/2007/EUROGIN2007Roadmap.pdf

    it's gratifying that they mention issues such as potential type replacement, lack of complete coverage, ongoing need for screening, superiority of hpv testing in that setting...gratifying except that they were mentioned on the YDB within days of the famous NEJM vaccine article with the accompanying (moronic) Crum editorial many years ago...nice to see that science can keep up with a bunch of dumb ass pumping geeks on a message board 5 years later

    it was pretty clear to all who were paying attention that this was how it would play out way back in 2002...11/14/02 to be exact which is the day the preliminary ACS recs came out...after that you had 21 trading days to buy as much digene stock as you could afford at prices between 7 and 8 ... from the lows of 2002, the s&p is up 71%, oil is up over 500%, and digene now qiagen is up 1200%

    there's still room to improve on that record although i think the next 5 years will only bring us up to about 2000% total, perhaps a bit more, from those lows in 2002 but not too shabby if, like many on the YDB, you kept the faith

    as you can see from the eurogin articles hpv testing will be with us for the forseeable future...change is slow and although there are new markers out there, and competing tests being developed, it will be quite a while before there is meaningful competition at the low throughput end, and even longer at the high and ultra-high end...the 800 pound gorilla has the resources and the deep pockets to develop or license the next big thing after primary hpv and genotyping, which is likely to be a further triage with more specific markers for true oncogenic risk but that will be years from now the way these "experts" move

    in the meantime, given that no one has both a competitive test AND an automated solution that will be on the market any sooner than say 2010 but more likely 2011 i like where qiagen sits...they will have their next gen out at the same time any competitors may be getting their 1st gen automated solution out with all the appropriate fda approvals...and with the coming crackdown on ASRs in Sept 2008 it will make for some pretty good open field running in the sweet spot of hpv adoption which is now in it's infancy...and you get the rest of qiagen which ain't too shabby

    of course i've been wrong before so take it fwiw ... ain't no law that says anyone has to believe a word i say! <gg>

 
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