A systematic review of the role of human papilloma virus (HPV) testing within a cervical screening programme: summary and conclusions

Abstract

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

Use of human papillomavirus DNA testing to compare equivocal cervical cytologic interpretations in the United States, Scandinavia, and the United Kingdom

“…Consequently, large and intensive research efforts are underway in several countries to increase the accuracy of programs by incorporation of testing for the etiologic agent of cervical carcinoma, human papillomavirus (HPV). [1][2][3][4][5][6] There is already substantial evidence that HPV testing can be used to manage equivocal cervical cytology. [7][8][9][10][11][12] However, cytologic diagnostic practices are known to vary between regions and countries.…”

Effectiveness of a two‐stage strategy with HPV testing followed by visual inspection with acetic acid for cervical cancer screening in a low‐income setting

“…When the specificity of a test is low, its clinical use can result in increased numbers of follow-up assessments, psychological concerns and unnecessary treatment. [40][41][42] Therefore, reducing the number of false positive cases while ensuring adequate identification of true cases is essential for the effectiveness of a screening program. A strategy usually employed to improve a screening test's utility is sequential testing, the second test being performed in women screened positive on the first test.…”

Prevalence of human papillomavirus infection in women in Turin, Italy

“…This finding has stimulated interest in HPV DNA testing as a means of screening for cervical cancer [3] and in the development of prophylactic and therapeutic vaccines against HPV [4].…”