Pooled hrHPV testing enables detection and treatment of precancers missed by cytology, thereby preventing more cancer than cytology alone.2
In a randomized controlled trial of 94,370 women, no cancers were found in the second round of screening among HPV-positive women referred to colposcopy in the first round, indicating that cancers within the HPV arm of the study were prevented by addressing precancers in the initial round.2
HPV-based screening reduces the incidence of cervical cancer within 4–5 years, compared with cytology-based screens.1,2
Pooled hrHPV testing has high sensitivity but lacks specificity, accurately identifying women harboring disease, but resulting in false identification of healthy women, leading to unnecessary colposcopy. Greater screening efficiencies can be achieved through further triage.3
|An HPV-negative result provides confidence||An HPV-positive result leaves questions|
|99% negative predictive value4||High risk of false-positives due to lack of specificity5|
|Long-term protective benefit of hrHPV is well proven4||False-positives have an unnecessary adverse psychosocial impact on women6|
|A women negative for HPV can be managed differently than a woman positive for high-risk genotypes7||Following each hrHPV-positive test with colposcopy places a large burden on the healthcare system|
|The screening interval can safely be extended for the HPV-negative women7||Dilemma: Inability to discern who would benefit from immediate colposcopy without further triage3|
Employ strategies that can detect women at highest risk for CIN2+, resulting in:
1. Rijkaart DC, Berkhof J, Rozendaal L, et al. Human papillomavirus testing for the detection for high-grade cervical intraepithelial neoplasia and cancer: final results of the POBASCAM randomized controlled trial. Lancet Oncol. 2012; 13:78-88.
2. Ronco G, Giorgi-Rossi P, Carozzi F, et al. Efficacy of human papillomavirus testing for the detection of invasive cervical cancers and cervical intraepithelial neoplasia: a randomised controlled trial. Lancet Oncol. 2010;11:249-257.
3. Cox JT, Castle PE, Behrens CM, et al. Comparison of cervical cancer screening strategies incorporating different combinations of cytology, HPV testing and genotyping for HPV 16/18: results from ATHENA HPV study. Am J Ob Gyn. 2012:in Press
4. Castle PE, Stoler MH, Wright TC Jr, Sharma A, Wright TL, Behrens CM. Performance of carcinogenic human papillomavirus (HPV) testing and HPV16 or HPV18 genotyping for cervical cancer screening of women aged 25 years and older: a subanalysis of the ATHENA study [published online August 23, 2011]. Lancet Oncol. doi:10.1016/S1470-2045(11)70188-7.
5. Saslow D, Solomon D. Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol. 2012; 137:516-542.
6. Gray NM, Sharp L, Cotton SC, et al. Psychological effects of a low-grade abnormal cervical smear test result: anxiety and associated factors. British J of Cancer. 2006;94:1253:1262.
7. Katki HA, Kinney WK, Fetterman B, et al. Cervical cancer risk for women undergoing concurrent testing for human papillomavirus and cervical cytology: a population-based study in routine clinical practice. Lancet Oncol. 2011;12(7):663-672.