Approaches for triaging women who test positive for human papillomavirus in cervical cancer screening

Abstract Substantial evidence exists to support the introduction of molecular testing for human papillomavirus (HPV) as the primary technology in cervical cancer screening. While HPV testing is much more sensitive than cytology for detection of high-grade precancerous lesions, it is less specific. T...

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Bibliographic Details
Published in:Preventive medicine 2017-05, Vol.98, p.15-20
Main Authors: Tota, Joseph E, Bentley, James, Blake, Jennifer, Coutlée, François, Duggan, Máire A, Ferenczy, Alex, Franco, Eduardo L, Fung-Kee-Fung, Michael, Gotlieb, Walter, Mayrand, Marie-Hélène, McLachlin, Meg, Murphy, Joan, Ogilvie, Gina, Ratnam, Sam
Format: Article
Language:English
Subjects:
Adult
Aged
Cervical cancer
Colposcopy
Early Detection of Cancer - methods
Female
HPV testing
Humans
Internal Medicine
Middle Aged
Papillomaviridae - isolation & purification
Referral and Consultation
Screening
Triage
Uterine Cervical Neoplasms - diagnosis
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Summary:Abstract Substantial evidence exists to support the introduction of molecular testing for human papillomavirus (HPV) as the primary technology in cervical cancer screening. While HPV testing is much more sensitive than cytology for detection of high-grade precancerous lesions, it is less specific. To improve efficiency, it is therefore recommended that a specific test (like cytology) be used in triaging HPV positive women to colposcopy. A number of studies have been conducted that support the use of cytology alone or in conjunction with HPV genotyping for triage. The decision to incorporate genotyping also depends on the commercial HPV test that is selected since not all tests provide results for certain individual high-risk types. Regardless of whether policy officials decide to adopt a triage approach that incorporates genotyping, the use of liquid based cytology (LBC) may also improve screening performance by reducing diagnostic delays. With LBC, the same cell suspension from a single collection may be used for HPV testing and a smear can be immediately prepared if HPV status is positive. This was a critical lesson from a community based demonstration project in Montreal (VASCAR study), where conventional cytology exists and specimen co-collection was not permitted for ethical reasons, requiring HPV positive women to return for an additional screening visit prior to colposcopy.
ISSN:0091-7435
1096-0260
DOI:10.1016/j.ypmed.2016.11.030