Abstract: Current cytology-based screening has a moderate sensitivity to detect cervical intraepithelial neoplasia grade 3 (CIN 3) and cervical cancer even in those states providing rigorous quality control of their cervical screening programs. The impact of vaccination against human papillomavirus (HPV) types 16 and 18 as well as the incorporation of HPV testing on the detection of CIN 3 and cancer is discussed. HPV testing used as a triage for atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions, test of cure after treatment, and HPV-based primary screening may improve current cervical screening programs.
HPV testing as a triage test for ASCUS seems to offer an improved sensitivity, with a similar specificity as compared to repeat cytology for diagnosing high-grade CIN and has been recommended throughout most EU states. HPV testing as a triage test for low-grade squamous intraepithelial lesions has a low specificity and is not recommended in most member states. HPV test of cure offers an improved sensitivity compared to cytology for women with persistent cervical precancer after treatment. HPV-based cervical cancer screening is more effective than screening with cytology. The effects of HPV-based screening depend on the organization of the program and on adherence to algorithms for screening triage. Otherwise, it is likely that HPV-based screening will increase the referral rate to colposcopy including more women with no detectable cervical lesion. HPV vaccination will require many years to evaluate any beneficial effects on cervical cancer incidence and mortality.
Cervical screening programs across Europe are influenced by implementing vaccination against human papillomavirus (HPV) and HPV testing. The impact on cervical cancer prevention is explored.
1Department of Obstetrics and Gynaecology, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK; 2Department of Gynecology, National Screening Center, Tbilisi, Georgia; 3Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium; 4Laboratoire Cerba, Paris, France; 5Department of Gynecology and Obstetrics, University of Bari, Bari, Italy; 6Hôpital Tenon, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Paris, France; 7Department of Obstetrics and Gynecology, Helsinki University Hospital, Finland; 8The Beacon Hospital, Sandyford, Dublin, Ireland; 9Department of Obstetrics and Gynaecology, University Hospital of North Staffordshire, Stoke-on-Trent, UK; 10D-18437 Stralsund, Grünthal, Germany; and 11Department of Obstetrics and Gynaecology, Klinikum Wolfsburg, Wolfsburg, Germany
Reprint requests to: Simon C. Leeson, FRCS, FRCOG, Department of Obstetrics and Gynaecology, Betsi Cadwaladr University Health Board (West), Gwynedd, Wales LL57 2PW, UK. E-mail: firstname.lastname@example.org
Dr Arbyn participated in the EUROGIN conference (Lisbon 2011) funded by organizers of the conference. Dr Arbyn received financial support from (1) Directorate of SANCO of the European Commission, Luxembourg, Grand-Duchy of Luxembourg), through the ECCG project (European Cooperation on development and implementation of Cancer screening and prevention Guidelines, the IARC, Lyon, France); (2) the 7th Framework Programme of DG Research of the European Commission through the PREHDICT project (grant no. 242061, coordinated by the Vrije Universiteit Amsterdam, the Netherlands) and the HPV-AHEAD project (FP7-HEALTH-2011-282562, coordinated by IARC); and (3) the Belgian Foundation Against Cancer (Brussels, Belgium). Dr Petry received unrestricted research grant from Sanofi Pasteur MSD for an HPV epidemiology study and a speaker’s honorarium from Roche, Qiagen, GSK, and Becton Dickinson Ad Board.
The other authors have declared they have no conflicts of interest.