HPV test kao primarni test skrininga u prevenciji cervikalnog karcinoma u Republici Hrvatskoj

Abstract

The knowledge that persistent infection with the human papillomavirus (HPV) is a necessary cause of cervical cancer has led to changes in strategies for the prevention and early detection of this cancer, with aim to eradicate it. Primary prevention through the use of vaccines that prevent HPV infection has been implemented since 2006, while secondary prevention of cervical cancer has been significantly improved by the introduction of the HPV test, either as the only method of primary screening or in combination with the Pap test. Screening based on the Pap smear has been unquestionably successful in reducing incidence and mortality in the last century. More recently, there have been gradual changes in the use of the HPV test, from its use as a reflex test after the detection of mild cytological abnormalities, through co-testing, to the use of the HPV test as the only test in primary screening thanks to the evidence gathered from the use of large, randomized research and meta-analysis. The advantages of using the HPV test over the Pap test include a higher sensitivity in detecting premalignant lesions, a higher negative predictive value of the test, and a safe extension of the time interval between screenings. However, the introduction of the HPV test as a primary screening test is not so simple and requires strict testing quality control and elaborate guidelines to ensure an optimal strategy and prevent additional burden on the healthcare system. This review presents the national cervical cancer screening program in the Republic of Croatia, the problems that prevented the start of a pilot project in one Croatian county selected for the introduction of the HPV test as a primary screening test in the prevention of cervical carcinoma, and the tasks ahead in the next period which would ensure the smooth implementation of the pilot project and implement the HPV test as the primary screening test in Croatia. Based on the results of the pilot project, it is necessary to precisely define: the age at which primary HPV testing should start and stop in the cervical cancer screening program, the examination interval after a negative primary HPV test, further procedures with women with a positive primary HPV test, the procedures for conducting reflex cytological testing and further treatment of the patient in accordance with the findings, the possibilities and justification of introducing self-sampling as part of the cervical cancer screening program based on the HPV test as the primary screening test, and finally the type of HPV test that is most suitable for the primary screening in Croatia.