Eurogin 2016 Roadmap: how HPV knowledge is changing screening practice

Abstract

Human papillomaviruses (HPVs) are the necessary cause of most cervical cancers, a large proportion of other anogenital cancers, and a subset of oropharyngeal cancers. The knowledge about HPV has led to development of novel HPV-based prevention strategies with important impact on clinical and public health practice. Two complementary reviews have been prepared following the 2015 Eurogin Conference to evaluate how knowledge about HPV is changing practice in HPV infection and disease control through vaccination and screening. This review focuses on screening for cervical and anal cancers in increasingly vaccinated populations. The introduction of HPV vaccines a decade ago has led to reductions in HPV infections and early cancer precursors in countries with wide vaccination coverage. Despite the high efficacy of HPV vaccines, cervical cancer screening will remain important for many decades. Many healthcare systems are considering switching to primary HPV screening, which has higher sensitivity for cervical precancers and allows extending screening intervals. We describe different approaches to implementing HPV-based screening efforts in different healthcare systems with a focus in high-income countries. While the population prevalence for other anogenital cancers is too low for population-based screening, anal cancer incidence is very high in HIV-infected men who have sex with men, warranting consideration of early detection approaches. We summarize the current evidence on HPV-based prevention of anal cancers and highlight important evidence gaps.

Eurogin roadmap 2017: Triage strategies for the management of HPV‐positive women in cervical screening programs

“…HPV testing for cervical cancer screening is now a reality with several countries, either adopting this modality at the program level or introducing it through the execution of regional pilot studies . Support for this approach to screening is also endorsed by various professional societies and organizations which have global influence and reach .…”

Recent advances in understanding and preventing human papillomavirus-related disease

“…Several countries are due to implement primary hrHPV testing with triage by cytology or, in some settings, partial genotyping 15 . Large randomised controlled trials have shown that hrHPV testing, when implemented over several rounds of screening, provided greater protection against CIN2+ or invasive cervical cancer than did cytological screening.…”

“…Even a single round of HPV testing can have a significant impact on the rate of advanced cervical cancers and cancer deaths in rural India 20 . Currently, the implementation of molecular testing in LMICs is limited because of cost and infrastructure requirements 15 . However, this might be addressed by using rapid low-cost point-of-care tests such as Xpert HPV, which has shown promise in a field trial in Papua New Guinea 21 .…”

Preparing for the Next Round of ASCCP-Sponsored Cervical Screening and Management Guidelines

“…There are now enough data to judge and guide the realistic clinical performance of multiple rounds of “cotesting” combining HPV testing with cytology. Second, young women vaccinated prophylactically against HPV have reached the age of screening, and HPV vaccination will increasingly and profoundly affect screening performance (8). Given the post-vaccination prevalence of precancer, cytology and pooled HPV tests perform less effectively (e.g., are less predictive of cervical precancer) in vaccinated populations than in unvaccinated populations.…”