The preferential strategies of programs of cervical virologic screening (publications review)

Abstract

Nowadays, the screening programs underwent global alterations due to low sensitivity and specificity against the background of significant increase of cervical oncopathology. The HPV testing became a major strategy of primary screening in many developed countries. The studies of organizational technologies of successful implementation of virologic screening are to bear on scientific justification of test choosing. To review scientific base of organizational technologies of primary virologic screening of cervical cancer with study of preferred criteria of selecting HPV test in world practice. The selection from scientific database PubMed and Google Scholar relevant publications over the past 15 years on organizational technologies of implementing methodologically validated virologic screening for cervical cancer was carried out. The world publications present evidence base of success in modifying organizational structure of cervical screening from PAP smear cytological screening to HPV testing. The necessary condition of efficiency was the organized screening covering at least 70% of female population of reproductive age, applying validated HPV assays as primary screening. The results of randomized clinical trials were the preferred strategies of selecting tests and primary screening programs. Currently, HPV testing is the preferred technology of primary cervical screening. The choice of specific HPV test is based on Mayer's criteria, including validation, information content, availability, identification of main HPV types of high oncogenic risk with typing, groups ranking for personalization of therapy and rehabilitation. To decrease subjectivity in organization of laboratory component in screening methodology, automation and standardization were applied in isolation of HPV DNA with cutting-off clinically insignificant results. The preferred strategies of selecting cervical virologic screening programs were results of multicenter randomized clinical trials, with significant evidence base of detection of cervical precancerous pathology and decrease of corresponding morbidity.