Current opinion in obstetrics & gynecology · 2013
Primary human papillomavirus testing in organized cervical screening.
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Dillner Joakim
Аннотация
PURPOSE OF REVIEW: An update on the use of human papillomavirus (HPV) testing as the primary screening test for advancing the effectiveness of organized cervical screening programs.
RECENT FINDINGS: Because HPV-based cervical screening has a protective effect of longer duration than cervical cytology, screening intervals can be lengthened for HPV-negative women. Under most scenarios of HPV test price and HPV prevalence, primary HPV screening is more cost-effective than primary screening with cytology. If cytology is used to triage HPV-positive women, colposcopy referral rates are not increased. However, there are logistical challenges to implement HPV-based screening, such as the need to ensure that HPV tests are used at increased screening intervals and in the correct age groups, the need to cope with the variety of different HPV tests, the limited international standardization and quality assurance, and the need to optimize and evaluate the method switch in the real-life setting.
SUMMARY: The necessary infrastructure to exploit the potential of HPV-based screening for improved cost-efficiency exists within organized, invitational screening programs. Piloting of HPV screening can be implemented by such programs, preferably as randomized healthcare policies.
RECENT FINDINGS: Because HPV-based cervical screening has a protective effect of longer duration than cervical cytology, screening intervals can be lengthened for HPV-negative women. Under most scenarios of HPV test price and HPV prevalence, primary HPV screening is more cost-effective than primary screening with cytology. If cytology is used to triage HPV-positive women, colposcopy referral rates are not increased. However, there are logistical challenges to implement HPV-based screening, such as the need to ensure that HPV tests are used at increased screening intervals and in the correct age groups, the need to cope with the variety of different HPV tests, the limited international standardization and quality assurance, and the need to optimize and evaluate the method switch in the real-life setting.
SUMMARY: The necessary infrastructure to exploit the potential of HPV-based screening for improved cost-efficiency exists within organized, invitational screening programs. Piloting of HPV screening can be implemented by such programs, preferably as randomized healthcare policies.