Human papillomavirus testing versus cytology in primary cervical cancer screening: End‐of‐study and extended follow‐up results from the Canadian cervical cancer screening trial

Isidean, Sandra D.; Mayrand, Marie‐Hélène; Ramanakumar, Agnihotram V.; Gilbert, Laura; Reid, Stephanie L.; Rodrigues, Isabel; Ferenczy, Alex; Ratnam, Sam; Coutlée, François; Franco, Eduardo L.

doi:10.1002/ijc.30385

Cited by 61 publications

(54 citation statements)

References 39 publications

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“…The rationale for extending primary HPV testing to younger women is not clear, but may be indicative of a universal screening mentality or a lack of understanding that the HPV infection in teenagers and women in their early 20’s often resolves or clears without intervention (Boardman and Robison, 2013). Many providers also followed an annual or 2-year screening interval for primary HPV testing, despite recommendations for a 3-year interval (Huh et al, 2015; American College of Obstetricians and Gynecologists, 2016) and evidence in other countries which supports the effectiveness of even longer intervals, up to 10 years (Peto and Gilham, 2017; Elfström et al, 2014; Dillner et al, 2008; Gage et al, 2014; Isidean et al, 2016). This preference for more frequent screening may reflect a lack of familiarity with screening recommendations (Isidean et al, 2016), concerns about maintaining visit volume (Henderson et al, 2014) or patient preference (Teoh et al, 2015; Gerend et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

“…Many providers also followed an annual or 2-year screening interval for primary HPV testing, despite recommendations for a 3-year interval (Huh et al, 2015; American College of Obstetricians and Gynecologists, 2016) and evidence in other countries which supports the effectiveness of even longer intervals, up to 10 years (Peto and Gilham, 2017; Elfström et al, 2014; Dillner et al, 2008; Gage et al, 2014; Isidean et al, 2016). This preference for more frequent screening may reflect a lack of familiarity with screening recommendations (Isidean et al, 2016), concerns about maintaining visit volume (Henderson et al, 2014) or patient preference (Teoh et al, 2015; Gerend et al, 2017). Primary HPV testing of women younger than recommended and screening more frequently than recommended will likely result in increased colposcopy referrals (Boardman and Robison, 2013) and adverse birth outcomes (Bjørge et al, 2016), with no accompanying rise in the detection of high-grade cervical disease.…”

Section: Discussionmentioning

confidence: 99%

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Primary HPV testing recommendations of US providers, 2015

Cooper¹,

Saraiya

2017

Preventive Medicine

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Objective To investigate the HPV testing recommendations of US physicians who perform cervical cancer screening. Methods Data from the 2015 DocStyles survey of U.S. health care providers were analyzed using multivariate logistic regression to identify provider characteristics associated with routine recommendation of primary HPV testing for average-risk, asymptomatic women ≥30 years old. The analysis was limited to primary care physicians and obstetrician-gynecologists who performed cervical cancer screening (N = 843). Results Primary HPV testing for average-risk, asymptomatic women ≥30 years old was recommended by 40.8% of physicians who performed cervical cancer screening, and 90.1% of these providers recommended primary HPV testing for women of all ages. The screening intervals most commonly recommended for primary HPV testing with average-risk, asymptomatic women ≥30 years old were every 3 years (35.5%) and annually (30.2%). Physicians who reported that patient HPV vaccination status influenced their cervical cancer screening practices were almost four times more likely to recommend primary HPV testing for average-risk, asymptomatic women ≥30 years old than other providers (Adj OR = 3.96, 95% CI = 2.82–5.57). Conclusion Many US physicians recommended primary HPV testing for women of all ages, contrary to guidelines which limit this screening approach to women ≥25 years old. The association between provider recommendation of primary HPV testing and patient HPV vaccination status may be due to anticipated reductions in the most oncogenic HPV types among vaccinated women.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Primary HPV testing recommendations of US providers, 2015

Cooper¹,

Saraiya

2017

Preventive Medicine

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“…Relative to cytology, hpv testing permits lengthening of screening intervals because of the much greater reassurance of safety to women. Should a woman's hpv test turn out negative, her short-and longterm risks of cervical lesions are very low relative to the implied safety conferred by a negative Pap test collected at the same time 6 . Testing for hpv dna or rna uses chemicallydefined, standardized, reproducible, and automatable assays that are much more tolerant to variations of specimen adequacy than cytology, a technique that requires subjective reading of smears prepared under rigorous quality control.…”

Section: El Franco Mph Drph Frsc Fcahs Ocmentioning

confidence: 99%

Self-Sampling for Cervical Cancer Screening: Empowering Women to Lead a Paradigm Change in Cancer Control

Franco

2018

Current Oncology

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In this new era of precision medicine and patient-centred care, the advent of self-sampling in cervical cancer screening is among the most disruptive innovations in cancer control and prevention. However, it has taken a long time to mature as an idea. The concept of self-sampling with swabs or brushes as a reliable substitute for providercollected cervical specimens has been the focus of at least 25 years of research. Although obtaining an adequate cytology specimen for cervical cancer screening served as the initial rationale 1 , it was the pragmatic goal of obtaining repeated samples for studying the natural history of genital human papillomavirus infection that drove much of this research 2,3 . The original aim of making the experience of participating in cervical cancer screening less daunting to women failed to be realized initially because the tradeoff between convenience to the woman and quality of the cervical sample was far from ideal.Given that it is an intuitively simple and attractive idea, why did it take so long for self-sampling to mature as a technological innovation? During most of the last 70 years, cervical cancer screening has been based on the Papanicolaou (Pap) cytology technique, which relies on the microscopic identification by a cytotechnician or cytopathologist of cellular abnormalities in optimally stained cervical samples smeared on glass slides. These samples must be representative of the ecto-and endocervix to be deemed adequate. For this to happen, a properly trained health care provider, i.e., a physician or nurse, must use a speculum to visualize the cervical os and transformation zone and collect cellular samples from the inner and outer perimeter of the latter using devices such as a wooden spatula, cytobrush, or broom-like device. The transformation zone perimeter is the origin of most neoplastic cervical lesions. Samples that do not properly reflect the cellular composition of the ecto-and endocervix are thus likely to yield false-negative cytology results in women with precancerous or cancerous lesions. Exceptionally, a cytotechnician reading such a Pap smear with meticulous attention to detail may fortuitously find an isolated cluster of dysplastic or malignant cells. However, an exhaustive smear scanning takes time. In the high-volume routine of most cytopathology laboratories, not more than a few minutes are spent per slide, which makes sample quality paramount in cervical cancer screening via cytology. The advent of liquid-based cytology improved the efficiency and ease of smear processing and reading but did not eliminate the need for a speculum-assisted and properly collected cervical sample by a health care provider. It is thus of no surprise that under the stringent quality control of specimen adequacy for cytology screening self-sampling never became much of a promise.The advent of molecular testing for nucleic acid of oncogenic genotypes of human papillomavirus (hpv) made self-sampling an attractive idea for cervical cancer screening again. Clinically validated hpv...

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“…Additional extended follow-up data from the Canadian Cervical Cancer Screening Trial (CCCaST) published since the interim guidance continue to support primary HPV screening. 21 Inherent to any discussion on cervical cancer screening is a consideration of the oft-stated fundamental principle guiding trends in cervical cancer screening guidelines: the balance between benefits and harms. Advocates for primary HPV screening state the concept that excess screening (ie, more frequent screening per older/traditional models) can lead to overtreatment of clinically insignificant disease in the form of both extra procedures and extra cost.…”

Section: Interim Guidancementioning

confidence: 99%

Primary High-Risk Human Papillomavirus Testing for Cervical Cancer Screening in the United States: Is It Time?

Flanagan

2018

Archives of Pathology &Amp; Laboratory Medicine

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Context.-The most recent update to cervical cancer screening guidelines offers interim guidance on the use of primary human papillomavirus (HPV) screening, with algorithms for management of results. After decades of screening with pure cytology and a shorter time with adjunctive HPV or cotesting with Papanicolaou (Pap) test and HPV, this is a significant change to our screening methods.Objective.-To briefly review the history of cervical cancer screening, the evidence upon which these interim guidelines were based, the arguments for and against primary HPV testing, and the current state of the field.Data Sources.-Primary studies, review articles, and commentaries were reviewed.Conclusions.-While there is evidence both for and against primary HPV testing, there are a growing number of countries adopting the practice. It would be worthwhile to be informed and prepared for such a change in the United States as well.

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Human papillomavirus testing versus cytology in primary cervical cancer screening: End‐of‐study and extended follow‐up results from the Canadian cervical cancer screening trial

Cited by 61 publications

References 39 publications

Primary HPV testing recommendations of US providers, 2015

Primary HPV testing recommendations of US providers, 2015

Self-Sampling for Cervical Cancer Screening: Empowering Women to Lead a Paradigm Change in Cancer Control

Primary High-Risk Human Papillomavirus Testing for Cervical Cancer Screening in the United States: Is It Time?

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