HPV infection and cervical cancer: a review of screening and preventive strategies in developed countries and brazilian policies

Abstract

Introduction: Cervical cancer is currently the third malignancy on number of female deaths in the world. Persistent HPV infection is the main agent involved in cervical cancer development, particularly of high risk (HR) HPV types 16 and 18, accountable for approximately 75% of cervical cancer cases. These aspect has increased demand for HPV detection molecular tests. Objectives: To summarise and update the current knowledge on HPV and cervical cancer screening techniques and, also, discuss HPV-related data and screening techniques in Brazil. Methods: We include articles published in the past 10 years, both in English and Portuguese. Scientific search engines as Scopus, Cochrane Library and Pubmed were used for the terms “cervical cancer”, “HPV”, “cervical carcinoma”, “HPV vaccine”. Only research articles and reviews were considered. Results: The most used techniques for HPV detection are PCR and Hybrid Capture 2 (HC2). However, techniques for detection of HPV E6/E7 mRNA and p16INK4a have been developed, which are still being validated. These tests may help distinguish transient from persistent HPV infections. Conclusion: To reduce the number of cervical cancer cases, screening strategies could be adjusted to contain the best combination of cytological and molecular tests. The ideal screening strategy require high sensitivity to minimize false negative results, and high specificity, to avoid false positives and over referral. Optimization may be achieved by using by co-testing, combining HPV genotyping and cytology triage with low-grade intraepithelial lesions (LSILs) or with atypical squamous cells of undetermined significance (ASC-US). Besides, strategies to prevent cervical cancer cases include HPV vaccination.