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The case for co-testing in cervical cancer screening

For more confident identification of precancer as early as the very first test

Pap Smear

A new approach to cervical cancer screening has emerged among healthcare providers determined to further reduce the incidence of cervical cancer: co-testing with Pap cytology and HPV testing (pooled and individual genotyping for HPV types 16 and 16/18) for women 30-65 years of age.

Pap cytology alone has a low degree of sensitivity with a single cycle of screening.1, 2 While sensitivity increases over several cycles, during that time, undetected disease may be progressing. In an overview of over 60,000 women, a single round of HPV testing has been shown to have a sensitivity of about 90% for cervical cancer and its precursor lesions,2 establishing Pap cytology together with HPV testing as superior over cytology alone in detecting precancer and cancer of the cervix.

1 in 10 women who are positive for HPV 16 and/or 18 have high-grade cervical disease that is missed by cytology.3

HPV testing combined with the widespread confidence in Pap cytology gives clinicians a greater opportunity to address precancer risk, and gives women greater certainty and less ambiguity around understanding their risk of cervical cancer. Here is what co-testing could mean for your practice:

  • Identification of women with precancer or at risk of precancer that are missed by Pap cytology
  • Enhanced risk-stratification that allows you to focus on those women in need of the greatest care, and reassure the vast majority that they are at very low risk and protect them from unnecessary interventions

Data supports the benefits of HPV testing.

A growing body of literature supports the benefits of pooled high-risk HPV (hrHPV) DNA testing when used with Pap cytology in cervical cancer screening of women aged 30 years or older. A large U.S. observational study showed that HPV testing promoted:4

  • Identification of women who developed cervical cancer, notably adenocarcinoma, an uncommon but particularly lethal form of cervical cancer whose precursors are poorly identified by Pap cytology alone
  • Safe screening interval extension for women with normal cytology who are also HPV negative

Hear from the experts:

Find out results from additional studies on the role of HPV testing.

The videos are intended to provide educational information and the opinions of the speakers may not be supported by Roche in their entirety.

  • Acronyms:


1. The ASCUS-LSIL Triage Study Group. Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance. Am J Obstet Gynecol. 2003;188(6):1383-1392.

2.Cuzick J, Clavel C, Petry K, et al. Overview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer. 2006;119(5):1095-1101.

3.Wright TC Jr, Stoler MH, Sharma A, et al. Evaluation of HPV-16 and HPV-18 genotyping for the triage of women with high-risk HPV+ cytology-negative results. Am J Clin Pathol. 2011;136(4):578-586.

4.Katki HA, Kinney WK, Fetterman B, et al. Cervical cancer risk for women undergoing concurrent human papillomavirus and cervical cytology: a population-based study in routine clinical practice. Lancet Oncol. 2011;12(7):663-672.