HPV trials update

Abstract

Background: More than ever, clinicians need regularly updated reviews given the continuously increasing amount of new information regarding innovative cervical cancer prevention methods.Methods: A summary is given from recently published meta‐analyses on three possible clinical applications of HPV DNA testing: triage of women with equivocal or low‐grade cytological abnormalities; prediction of the therapeutic outcome after treatment of CIN lesions, and last not but not least, primary screening for cervical cancer and pre‐cancer.Results: Consistent evidence is available indicating thatHPV‐triage with the Hybrid Capture‐2 assay (HC2) is more accurate (significantly higher sensitivity, similar specificity) than repeat cytology to triage women with equivocal Pap smear results. When triaging women with LSIL, a reflex HC2 test shows a not significantly higher sensitivity, but a substantially and significantly lower specificity compared to a repeat Pap smear. After conservative treatment of cervical lesions, HPV testing picks up more quickly, with higher sensitivity and not lower specificity residual or recurrent CIN than follow‐up cytology. Primary screening with HC2 generally detects 23% (95% CI: 13%–23%) more CIN2+ compared to cytology at the lowest cutoff ASCUS or LSIL, but is 6% (95% CI: 4%–8%) less specific. By combined HPV and cytology screening a further 4% (95% CI: 3%–5%) more CIN3 lesions can be identified but at the expense of a 7% (95% CI: 5%–9%) loss in specificity, in comparison with isolated HC2 screening.Conclusions: Sufficient evidence exists to recommend HPV testing in triage of women with atypical cytology and in surveillance after treatment of CIN lesions. In the United States, recently reviewed knowledge has resulted in the approval of combined cytology and HC2 primary screening in women older than 30 years. However, in Europe, cytology‐based screening still remains the standard screening method. The European screening policy will be reviewed based on the results of randomized population trials which are currently underway.