HPV Screening: Available Data and Recommendations for Clinical Practice

Guglielmo      Ronco; Chris      J.L.M. Meijer

Abstract

Cervical screening based on testing for the DNA of high-risk HPV types as primary screening test detects the precursors of cervical cancers earlier than cytology. This allows longer screening intervals and results in increased effectiveness in preventing invasive cervical cancers. Data suggest that protection is similar irrespective whether sole HPV testing or HPV in conjunction with cytology are applied as primary tests. In addition, protection seems similar when directly referring all HPV positive women to colposcopy and when referring only women with abnormal cytology or persistent infection (cytological triage). On the other hand, using both tests for primary screening, and especially directly referring to colposcopy all HPV positive women, results in a strong increase of unneeded colposcopies. Therefore stand-alone HPV testing as primary test, at prolonged intervals, with cytological triage is recommendable. With this approach the positive predictive value of colposcopy is similar to that obtained with cytological screening. In younger women HPV based screening could result in large overdiagnosis of regressive lesions and should therefore be avoided. Other triage methods, based on simple HPV test repeat, viral load, p16-INK4A overexpression and testing for the HPV E6/E7 mRNA are under study. Self sampling for HPV is sensitive and specific. Among non-responders to routine screening it obtained higher compliance than regular re-invitation and allowed a relevant yield of CIN2+.

Keywords: Cervical cancer, screening, human papillomavirus