The new screening program to prevent cervical cancer using HPV DNA: getting the balance right in maintaining quality

Abstract

Along with the reduction in human papillomavirus (HPV) infection and cervical abnormalities as a result of the successful HPV vaccination program, Australia is adopting a new screening strategy. This involves a new paradigm moving from cervical cytological screening to molecular nucleic acid technology (NAT), using HPV DNA assays as primary screening methodology for cervical cancer prevention. These assays must strike a balance between sufficient clinical sensitivity to detect or predict high‐grade cervical intraepithelial lesions, the precursor to cervical cancer, without being too sensitive and detecting transient infection not destined for disease. Ensuring the highest quality HPV NAT is thus a priority in order to reduce the possibility of falsely negative screens and manage the risk associated with false positive HPV NAT test results. How to do this needs informed discussion and on‐going refinement of the screening algorithm. This is of relevance as more countries move to more sensitive HPV NAT tests for secondary prevention of cervical cancer and as more HPV assays become available.

Detection of high‐grade cervical disease among women referred directly to colposcopy after a positive HPV screening test varies with age and cytology findings

“…The results presented reflect the risk of standardised management algorithms. 22,24 In conclusion, data describing the first cross-sectional findings on the performance of Australia's newly introduced HPV-based cervical screening program showed a high predictive value of HPV testing for detecting cervical high-grade disease among women referred directly for colposcopy. The predictive value of HPV testing showed a significant variation in age, particularly among women over the age of 55 which warrants further monitoring.…”

“…A major strength is that these results represent real‐world experience as part of Australia's new national cervical cancer screening program. The colposcopy and laboratory testing have all been performed by clinicians and laboratories licenced to do this testing and management, operating under national laboratory accreditation guidelines, as well as colposcopy quality guidelines and national standardised management algorithms 22,24 …”

Risk stratification for cervical neoplasia using extended high‐risk HPV genotyping in women with ASC‐US cytology: A large retrospective study from China

“…In the future, the experience of countries already using primary hrHPV screening, such as the Netherlands and Australia, 45,46 should help clarify the challenge of trying to avoid over referral of screened women to colposcopy and possible overtreatment against the limitations of hrHPV testing. Extended hrHPVGT is likely to continue to be explored in various screening settings as earlier hrHPV‐vaccinated cohorts age and as a portion of the screening population.…”

Vacuna del VPH: elementos conceptuales ginecol�gicos, �ticos y bio�ticos

“…Otro camino para la detección precoz del cáncer de cuello uterino es la utilización de la tecnología del ácido nucleico molecular aplicado al ADN del VPH 6 . También ha surgido la utilización de medios para detectar biomarcadores en sangre como alternativa para el diagnóstico precoz del cáncer 7 .…”