Results from an 8-year trial involving more than 130,000 women published in The New England Journal of Medicine (360:1385-1394, 2009) demonstrate that in low-resource settings, a single round of human papillomavirus (HPV) testing significantly reduces the numbers of advanced cervical cancers and deaths, compared with Pap testing or visual inspection with acetic acid (VIA). This was the first randomized controlled trial to measure incidence of cervical cancer and associated rates of death as the primary outcomes, using different tools for screening.
In addition to being “associated with a significant reduction in the numbers of advanced cervical cancers and deaths from cervical cancer,” HPV testing “was the most objective and reproducible of all cervical cancer screening tests and was less demanding in terms of training and quality assurance,” the study authors state.
“The implications of the findings of this trial are immediate and global: international experts in cervical-cancer prevention should now adapt HPV testing for widespread implementation,” wrote Drs. Mark Schiffman and Sholom Wacholder of the US National Cancer Institute in an editorial that accompanied the study in the NEJM.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
