In a prospective cohort study 8466 women attending routine cervical cancer screening were recruited. Colposcopy was performed on women with any degree of atypia on cytology and/or a positive high-risk human papillomavirus (HPV)-DNA test (HC2; Hybrid Capture 2 r ), and for a randomly selected sample of 3.4% women with negative findings on both. Quality control included reviews of cytology, histology, colposcopy images and retesting of samples with polymerase chain reaction. Test diagnostic performances were based on 7908 women who had complete baseline and follow-up results. Routine histology identified 86 women with high-grade cervical intraepithelial neoplasia (CIN2 þ ), which was confirmed by review histology in only 46 cases. Sensitivity of routine cytology for the detection of CIN2 þ was 43.5%, with a specificity, positive predictive value (PPV), negative predictive value (NPV) of 98.0, 11.4 and 99.7%, respectively. Sensitivity of the HC2 test for the detection of CIN2 þ was 97.8%, with a specificity, PPV and NPV, of 95.3, 10.9 and 100%, respectively. No high-grade neoplasia was detected in the randomly selected control group. A negative HPVtest result, even in combination with a positive Papanicolaou (Pap) result, virtually excluded any risk of underlying high-grade disease, but this was not the case for a negative Pap result. These data show that HPV testing is of value for the detection or exclusion of prevalent CIN in a routine cervical cancer-screening setting and could be used for further risk classification of women for follow-up management.

5 ECCA (European cervical cancer association) Brussels, Belgium Today in France, low attendance to cervical screening by Papanicolaou cytology (Pap-smear) is a major contributor to the 3,000 new cervical cancer cases and 1,000 deaths that occur from this disease every year. Nonattenders are mostly from lower socioeconomic groups and testing of self-obtained samples for high-risk Human Papilloma virus (HPV) types has been proposed as a method to increase screening participation in these groups. In 2011, we conducted a randomized study of women aged 35-69 from very low-income populations around Marseille who had not responded to an initial invitation for a free Pap-smear. After randomization, one group received a second invitation for a free Pap-smear and the other group was offered a free self-sampling kit for HPV testing. Participation rates were significantly different between the two groups with only 2.0% of women attending for a Pap-smear while 18.3% of women returned a self-sample for HPV testing (p 0.001). The detection rate of high-grade lesions ( CIN2) was 0.2& in the Pap-smear group and 1.25& in the self-sampling group (p 5 0.01). Offering self-sampling increased participation rates while the use of HPV testing increased the detection of cervical lesions ( CIN2) in comparison to the group of women receiving a second invitation for a Pap-smear. However, low compliance to follow-up in the self-sampling group reduces the effectiveness of this screening approach in nonattenders women and must be carefully managed.Cervical cancer screening with Papanicolaou cytology (Papsmear) has markedly decreased cervical cancer rates in those high-income countries where it has been effectively implemented. In France, from 1980 to 2009, age standardized incidence rates (world population) decreased from 14.9 to 6.4/ 100,000, while cervical cancer mortality decreased from 5.4 to 1.7/100,000. 1 Irregular or nonattendance to screening is the principal cause of the 3,000 new cervical cancers diagnosed annually in France today and which lead to 1,000 deaths each year. Various studies show that 60-65% of women diagnosed with invasive cervical cancer have not been regularly screened. 2 In France, cervical screening is opportunistic but the widespread availability of services combined with cultural factors has led to good coverage of the target population and irregular or nonattenders are now mostly from lower socioeconomic groups or women over the age of 55 years with cultural barriers toward clinical gynecological examination. 3,4 One project to increase the participation rate in these groups introduced an organized screening process for women living in the northern suburbs of Marseille (France) where the majority are immigrants living on low incomes. In 2001, women with no Pap-smears recorded during the past 2 years were sent a personal letter inviting them to consult their general practitioner for a free Pap-smear but only 1.8% of the women participated. In 2003, the process was repeated with women invited to have a free Pap-sm...

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A systematic review of the available evidence on the role of HPV testing in cervical screening has been published by the Health Technology Assessment Committee of the UK Department of Health. The review summarized relevant data on testing methods, natural history, and prevalence of the virus in different disease groups. Cost-effectiveness modelling was undertaken. Ten major conclusions were reached and are reported here. The key conclusions were that HPV testing was more sensitive than cytology, but that there were concerns about specificity, especially in young women. The increased sensitivity led to a recommendation that HPV testing be introduced on a pilot basis for women with borderline and mild smears. HPV testing has great potential as a primary screening test, but large trials are needed to properly evaluate this application and to determine if its introduction can reduce invasive cancer rates. There is an urgent need to undertake a large trial of HPV testing in conjunction with other new technologies (liquid-based cytology and computer-assisted cytology reading) to determine the best way to integrate them into ongoing screening programmes. A range of issues including the age to start and stop screening, the appropriate screening interval, the role of self-sampling for HPV testing and the choice of primary test (HPV and/or cytology) require further evaluation. © 2000 Cancer Research Campaign

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