Can HPV Testing Be Used as a First-line Screening Test for Cervical Cancer Prevention? Three-year Cumulative Risk of CIN2+ In Women Aged 30 Years and Older Screened by Pap and HPV Co-testing

Abstract

Introduction: Over time, cervical screening has evolved from a simple glass-slide smear to a sophisticated test involving liquid-based processing, automated screening, and molecular human papillomavirus (HPV) testing. Recent emphasis on molecular testing seeks to identify HPV strains considered “high-risk” for carcinogenesis, with HPV 16 & 18 being the main focus of research and clinical practice. But is molecular testing more effective and efficient than morphologic testing for cervical screening? Does current data on HPV hold true across all populations? As a public health laboratory serving high-risk, underserved populations, these remain important considerations for our practice. Materials and Methods: Correlation of Pap and HPV results was performed via retrospective review, focusing on Pap cases with high-grade diagnoses and an associated HPV test using the cobas 4800 HPV platform from Roche Diagnostics. HPV results included HPV 16, HPV 18, HPV Other High-Risk, a combination of two or more groups, or HPV Not Detected. The subject population consisted mostly of young women within 200% or less of the poverty line. Results: Of 2,818 cytology test cases reviewed from July 2013-March 2014, 74 were diagnosed as high-grade. HPV was not detected in 10 (13.51%) of these cases. Of the 64 positive HPV tests, 25 (39.06%) fell in the Other High-Risk category. In total, 35 (52.57%) of the high-grade Pap cases were not HPV 16/18 positive. Conclusions: With recent changes to cervical screening practices and guidelines, namely the emphasis on molecular HPV testing, the results of this review are concerning. How will these changes in screening affect our bottom line, both financially and prognostically? Is our patient population substantially different from those used to develop popular testing algorithms? As we move forward with evolution of cervical screening practices, it will be important to explore these questions for the continued quality and integrity of women’s health services.