Abstract
Testing for the DNA of high-risk types of papilloma virus (HPV) is more sensitive than cytology in detecting pre-cancerous lesions. One of the main advantages will be the possibility of applying prolonged screening intervals. However adequate screening protocols (age of start and stop, screening intervals, management of HPV positive women) need to be applied in order to avoid over-referral to colposcopy and over-treatment and to maintain sustainable costs. Further follow-up of running trials and research on molecular markers will better define these parameters. The new situation will require organised screening programmes with rigorous protocols and monitoring. This will be even more needed when women vaccinated for HPV 16 and 18 will be screened. Research on how to best screen vaccinated women is a priority. This paper proposes an overview of the plausible impact of new technologies in cervical cancer screening in the near future and in the vaccinated cohorts.
Highlights
Human Papilloma virus (HPV) as primary screening test of cervical cancer precursors Both studies based on double-testing of the same women [1,2] and large population trials [3,4,5,6,7,8] showed that testing for the DNA of high-risk HPV types is more sensitive but less specific than conventional cytology in identifying high-grade cervical intraepithelial neoplasia (CIN)
Almost the same sensitivity is obtained with HPV alone as with both cytology and HPV together as primary screening tests
In women at least 35 years of age, in the "New Technology in Cervical Cancer" (NTCC) trial, HPV testing was found to be 63% more sensitive than cytology when all HPVpositive women are referred to colposcopy [8]
Summary
Human Papilloma virus (HPV) as primary screening test of cervical cancer precursors Both studies based on double-testing of the same women [1,2] and large population trials [3,4,5,6,7,8] showed that testing for the DNA of high-risk HPV types is more sensitive but less specific than conventional cytology in identifying high-grade cervical intraepithelial neoplasia (CIN). In women at least 35 years of age, in the "New Technology in Cervical Cancer" (NTCC) trial, HPV testing was found to be 63% more sensitive than cytology when all HPVpositive women are referred to colposcopy [8]. At this age loss in specificity is small: in a pooled analysis of European and North American studies based on double-testing [1], specificity was 93.3% with HPV DNA testing vs 97.1% with cytology. Among women 25–34 years of age, in the NTCC trial, HPV testing with cytological triage resulted in a relative sensitivity vs cytology of 1.58 with only a moderate loss in PPV (relative PPV 0.78) [4]. Results from the follow-up of the NTCC study, currently under analysis, will provide information on the appropriateness of HPV screening at younger ages
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