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. 1995 Feb 15;152(4):483–493.

Periodic health examination, 1995 update: 1. Screening for human papillomavirus infection in asymptomatic women. Canadian Task Force on the Periodic Health Examination.

K Johnson 1
PMCID: PMC1337702  PMID: 7859196

Abstract

OBJECTIVE: To develop recommendations for practising physicians on the advisability of screening for human papillomavirus (HPV) infection in asymptomatic women. OPTIONS: Visual inspection, Papanicolaou testing, colposcopy or cervicography, use of HPV group-specific antigen, DNA hybridization, dot blot technique, Southern blot technique or polymerase chain reaction followed by physical or chemical therapeutic intervention. OUTCOMES: Evidence for a link between HPV infection and cervical cancer, sensitivity and specificity of HPV screening techniques, effectiveness of treatments for HPV infection, and the social and economic costs incurred by screening. EVIDENCE: MEDLINE was searched for articles published between January 1966 to June 1993 with the use of the key words "papillomavirus," "cervix neoplasms," "mass screening," "prospective studies," "prevalence," "sensitivity," "specificity," "human" and "female." VALUES: Proven cost-effective screening techniques that could lead to decreased morbidity or mortality were given a high value. The evidence-based methods and values of the Canadian Task Force on the Periodic Health Examination were used. BENEFITS, HARMS AND COSTS: Potential benefits are to prevent cervical cancer and eliminate HPV infection. Potential harmful effects include the creation of an unnecessary burden on the health care system and the labelling of otherwise healthy people as patients with a sexually transmitted disease for which therapy is generally ineffective. Potential costs would include expense of testing, increased use of colposcopy and treatment. RECOMMENDATIONS: There is fair evidence to exclude HPV screening (beyond Papanicolaou testing for cervical cancer) in asymptomatic women (grade D recommendation). VALIDATION: The report was reviewed by members of the task force and three external reviewers who were selected to represent different areas of expertise. SPONSORS: These guidelines were developed and endorsed by the task force, which is funded by Health Canada and the National Health Research and Development Program. The principal author (K.J.) was supported in part by the National Health Research and Development Program through a National Health Fellowship (AIDS).

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Selected References

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  1. Armstrong B. K., Allen O. V., Brennan B. A., Fruzynski I. A., de Klerk N. H., Waters E. D., Machin J., Gollow M. M. Time trends in prevalence of cervical cytological abnormality in women attending a sexually transmitted diseases clinic and their relationship to trends in sexual activity and specific infections. Br J Cancer. 1986 Oct;54(4):669–675. doi: 10.1038/bjc.1986.225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Borst M., Butterworth C. E., Baker V., Kuykendall K., Gore H., Soong S. J., Hatch K. D. Human papillomavirus screening for women with atypical Papanicolaou smears. J Reprod Med. 1991 Feb;36(2):95–99. [PubMed] [Google Scholar]
  3. Campion M. J., McCance D. J., Cuzick J., Singer A. Progressive potential of mild cervical atypia: prospective cytological, colposcopic, and virological study. Lancet. 1986 Aug 2;2(8501):237–240. doi: 10.1016/s0140-6736(86)92067-2. [DOI] [PubMed] [Google Scholar]
  4. Carmichael J. A., Maskens P. D. Cervical dysplasia and human papillomavirus. Am J Obstet Gynecol. 1989 Apr;160(4):916–918. doi: 10.1016/0002-9378(89)90310-4. [DOI] [PubMed] [Google Scholar]
  5. Chow V. T., Tay S. K., Tham K. M., Lim-Tan S. K., Bernard H. U. Subclinical human papillomavirus infection of the male lower genital tract: colposcopy, histology and DNA analysis. Int J STD AIDS. 1991 Jan-Feb;2(1):41–45. doi: 10.1177/095646249100200108. [DOI] [PubMed] [Google Scholar]
  6. Cobb M. W. Human papillomavirus infection. J Am Acad Dermatol. 1990 Apr;22(4):547–566. doi: 10.1016/0190-9622(90)70073-q. [DOI] [PubMed] [Google Scholar]
  7. Collins R. J., Ngan H. Y., Hsu C., Cheung A., King P., Pun T. C., Ma H. K., Srivastava G. Human papillomavirus infection in the cervix of pregnant females in Hong Kong. Cytopathology. 1990;1(3):147–152. doi: 10.1111/j.1365-2303.1990.tb00340.x. [DOI] [PubMed] [Google Scholar]
  8. Dunham A. M., McCartney J. C., McCance D. J., Taylor R. W. Effect of perilesional injection of alpha-interferon on cervical intraepithelial neoplasia and associated human papillomavirus infection. J R Soc Med. 1990 Aug;83(8):490–492. doi: 10.1177/014107689008300804. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Eron L. J., Judson F., Tucker S., Prawer S., Mills J., Murphy K., Hickey M., Rogers M., Flannigan S., Hien N. Interferon therapy for condylomata acuminata. N Engl J Med. 1986 Oct 23;315(17):1059–1064. doi: 10.1056/NEJM198610233151704. [DOI] [PubMed] [Google Scholar]
  10. Ferenczy A., Mitao M., Nagai N., Silverstein S. J., Crum C. P. Latent papillomavirus and recurring genital warts. N Engl J Med. 1985 Sep 26;313(13):784–788. doi: 10.1056/NEJM198509263131304. [DOI] [PubMed] [Google Scholar]
  11. Fisher M., Rosenfeld W. D., Burk R. D. Cervicovaginal human papillomavirus infection in suburban adolescents and young adults. J Pediatr. 1991 Nov;119(5):821–825. doi: 10.1016/s0022-3476(05)80311-7. [DOI] [PubMed] [Google Scholar]
  12. Gissmann L., Boshart M., Dürst M., Ikenberg H., Wagner D., zur Hausen H. Presence of human papillomavirus in genital tumors. J Invest Dermatol. 1984 Jul;83(1 Suppl):26s–28s. doi: 10.1111/1523-1747.ep12281143. [DOI] [PubMed] [Google Scholar]
  13. Horn J. E., McQuillan G. M., Shah K. V., Gupta P., Daniel R. W., Ray P. A., Quinn T. C., Hook E. W., 3rd Genital human papillomavirus infections in patients attending an inner-city STD clinic. Sex Transm Dis. 1991 Jul-Sep;18(3):183–187. doi: 10.1097/00007435-199107000-00012. [DOI] [PubMed] [Google Scholar]
  14. Jarrett W. F., McNeil P. E., Grimshaw W. T., Selman I. E., McIntyre W. I. High incidence area of cattle cancer with a possible interaction between an environmental carcinogen and a papilloma virus. Nature. 1978 Jul 20;274(5668):215–217. doi: 10.1038/274215a0. [DOI] [PubMed] [Google Scholar]
  15. Kirby P., Dunne A., King D. H., Corey L. Double-blind randomized clinical trial of self-administered podofilox solution versus vehicle in the treatment of genital warts. Am J Med. 1990 May;88(5):465–469. doi: 10.1016/0002-9343(90)90424-c. [DOI] [PubMed] [Google Scholar]
  16. Kitchener H. C., Neilson L., Burnett R. A., Young L., Macnab J. C. Prospective serial study of viral change in the cervix and correlation with human papillomavirus genome status. Br J Obstet Gynaecol. 1991 Oct;98(10):1042–1048. doi: 10.1111/j.1471-0528.1991.tb15344.x. [DOI] [PubMed] [Google Scholar]
  17. Koutsky L. A., Galloway D. A., Holmes K. K. Epidemiology of genital human papillomavirus infection. Epidemiol Rev. 1988;10:122–163. doi: 10.1093/oxfordjournals.epirev.a036020. [DOI] [PubMed] [Google Scholar]
  18. Koutsky L. A., Holmes K. K., Critchlow C. W., Stevens C. E., Paavonen J., Beckmann A. M., DeRouen T. A., Galloway D. A., Vernon D., Kiviat N. B. A cohort study of the risk of cervical intraepithelial neoplasia grade 2 or 3 in relation to papillomavirus infection. N Engl J Med. 1992 Oct 29;327(18):1272–1278. doi: 10.1056/NEJM199210293271804. [DOI] [PubMed] [Google Scholar]
  19. Macnab J. C., Walkinshaw S. A., Cordiner J. W., Clements J. B. Human papillomavirus in clinically and histologically normal tissue of patients with genital cancer. N Engl J Med. 1986 Oct 23;315(17):1052–1058. doi: 10.1056/NEJM198610233151703. [DOI] [PubMed] [Google Scholar]
  20. Mandal D., Haye K. R., Ray T. K., Goorney B. P., Stanbridge C. M., Corbitt G. Prevalence of occult human papillomavirus infection, determined by cytology and DNA hybridization, in heterosexual men attending a genitourinary medicine clinic. Int J STD AIDS. 1991 Sep-Oct;2(5):351–355. doi: 10.1177/095646249100200508. [DOI] [PubMed] [Google Scholar]
  21. McCance D. J., Campion M. J., Clarkson P. K., Chesters P. M., Jenkins D., Singer A. Prevalence of human papillomavirus type 16 DNA sequences in cervical intraepithelial neoplasia and invasive carcinoma of the cervix. Br J Obstet Gynaecol. 1985 Nov;92(11):1101–1105. doi: 10.1111/j.1471-0528.1985.tb03019.x. [DOI] [PubMed] [Google Scholar]
  22. McKinnon K. J., Ford R. M., Hunter J. C. High prevalence of human papillomavirus and cervical intraepithelial neoplasia in a young Australian STD population. Int J STD AIDS. 1991 Jul-Aug;2(4):276–279. doi: 10.1177/095646249100200410. [DOI] [PubMed] [Google Scholar]
  23. Meisels A., Morin C. Human papillomavirus and cancer of the uterine cervix. Gynecol Oncol. 1981 Oct;12(2 Pt 2):S111–S123. doi: 10.1016/0090-8258(81)90066-4. [DOI] [PubMed] [Google Scholar]
  24. Miller A. B., Anderson G., Brisson J., Laidlaw J., Le Pitre N., Malcolmson P., Mirwaldt P., Stuart G., Sullivan W. Report of a National Workshop on Screening for Cancer of the Cervix. CMAJ. 1991 Nov 15;145(10):1301–1325. [PMC free article] [PubMed] [Google Scholar]
  25. Mitchell H., Drake M., Medley G. Prospective evaluation of risk of cervical cancer after cytological evidence of human papilloma virus infection. Lancet. 1986 Mar 15;1(8481):573–575. doi: 10.1016/s0140-6736(86)92807-2. [DOI] [PubMed] [Google Scholar]
  26. Pagano R., Chanen W., Rome R. M., Johnstone N. R. The significance of human papilloma virus atypia ('wart virus infection') found alone on cervical cytology screening. Aust N Z J Obstet Gynaecol. 1987 May;27(2):136–139. doi: 10.1111/j.1479-828x.1987.tb00964.x. [DOI] [PubMed] [Google Scholar]
  27. Phillips T. J., Dover J. S. Recent advances in dermatology. N Engl J Med. 1992 Jan 16;326(3):167–178. doi: 10.1056/NEJM199201163260305. [DOI] [PubMed] [Google Scholar]
  28. Rader J. S., Rosenzweig B. A., Spirtas R., Padleckas R., Javaheri G., Gerardo L., Laimins L. A. Atypical squamous cells. A case-series study of the association between papanicolaou smear results and human papillomavirus DNA genotype. J Reprod Med. 1991 Apr;36(4):291–297. [PubMed] [Google Scholar]
  29. Reeves W. C., Brinton L. A., García M., Brenes M. M., Herrero R., Gaitán E., Tenorio F., de Britton R. C., Rawls W. E. Human papillomavirus infection and cervical cancer in Latin America. N Engl J Med. 1989 Jun 1;320(22):1437–1441. doi: 10.1056/NEJM198906013202201. [DOI] [PubMed] [Google Scholar]
  30. Reeves W. C., Rawls W. E., Brinton L. A. Epidemiology of genital papillomaviruses and cervical cancer. Rev Infect Dis. 1989 May-Jun;11(3):426–439. doi: 10.1093/clinids/11.3.426. [DOI] [PubMed] [Google Scholar]
  31. Reid R., Greenberg M. D., Lorincz A., Jenson A. B., Laverty C. R., Husain M., Daoud Y., Zado B., White T., Cantor D. Should cervical cytologic testing be augmented by cervicography or human papillomavirus deoxyribonucleic acid detection? Am J Obstet Gynecol. 1991 Jun;164(6 Pt 1):1461–1471. doi: 10.1016/0002-9378(91)91425-v. [DOI] [PubMed] [Google Scholar]
  32. Reid R., Greenberg M., Jenson A. B., Husain M., Willett J., Daoud Y., Temple G., Stanhope C. R., Sherman A. I., Phibbs G. D. Sexually transmitted papillomaviral infections. I. The anatomic distribution and pathologic grade of neoplastic lesions associated with different viral types. Am J Obstet Gynecol. 1987 Jan;156(1):212–222. doi: 10.1016/0002-9378(87)90241-9. [DOI] [PubMed] [Google Scholar]
  33. Ritter D. B., Kadish A. S., Vermund S. H., Romney S. L., Villari D., Burk R. D. Detection of human papillomavirus deoxyribonucleic acid in exfoliated cervicovaginal cells as a predictor of cervical neoplasia in a high-risk population. Am J Obstet Gynecol. 1988 Dec;159(6):1517–1525. doi: 10.1016/0002-9378(88)90587-x. [DOI] [PubMed] [Google Scholar]
  34. Riva J. M., Sedlacek T. V., Cunnane M. F., Mangan C. E. Extended carbon dioxide laser vaporization in the treatment of subclinical papillomavirus infection of the lower genital tract. Obstet Gynecol. 1989 Jan;73(1):25–30. [PubMed] [Google Scholar]
  35. Rohan T., Mann V., McLaughlin J., Harnish D. G., Yu H., Smith D., Davis R., Shier R. M., Rawls W. PCR-detected genital papillomavirus infection: prevalence and association with risk factors for cervical cancer. Int J Cancer. 1991 Dec 2;49(6):856–860. doi: 10.1002/ijc.2910490609. [DOI] [PubMed] [Google Scholar]
  36. Ruge S., Felding C., Skouby S. O., Lundvall F., Hørding U. CO2-laser vaporization of human papillomavirus (HPV)-induced abnormal cervical smears. A simple and effective solution to a recurrent clinical problem. Clin Exp Obstet Gynecol. 1991;18(2):99–101. [PubMed] [Google Scholar]
  37. Schiffman M. H., Bauer H. M., Hoover R. N., Glass A. G., Cadell D. M., Rush B. B., Scott D. R., Sherman M. E., Kurman R. J., Wacholder S. Epidemiologic evidence showing that human papillomavirus infection causes most cervical intraepithelial neoplasia. J Natl Cancer Inst. 1993 Jun 16;85(12):958–964. doi: 10.1093/jnci/85.12.958. [DOI] [PubMed] [Google Scholar]
  38. Schiffman M. H. Recent progress in defining the epidemiology of human papillomavirus infection and cervical neoplasia. J Natl Cancer Inst. 1992 Mar 18;84(6):394–398. doi: 10.1093/jnci/84.6.394. [DOI] [PubMed] [Google Scholar]
  39. Schneider A., Meinhardt G., De-Villiers E. M., Gissmann L. Sensitivity of the cytologic diagnosis of cervical condyloma in comparison with HPV-DNA hybridization studies. Diagn Cytopathol. 1987 Sep;3(3):250–255. doi: 10.1002/dc.2840030315. [DOI] [PubMed] [Google Scholar]
  40. Shafi M. I., Finn C., Luesley D. M., Jordan J. A., Rollason T. P. Carbon dioxide laser treatment for vulval papillomatosis (vulvodynia). Br J Obstet Gynaecol. 1990 Dec;97(12):1148–1150. doi: 10.1111/j.1471-0528.1990.tb02505.x. [DOI] [PubMed] [Google Scholar]
  41. Shun-Zhang Y., Miller A. B., Sherman G. J. Optimising the age, number of tests, and test interval for cervical screening in Canada. J Epidemiol Community Health. 1982 Mar;36(1):1–10. doi: 10.1136/jech.36.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Spitzer M., Brandsma J. L., Steinberg B., Chernys A. E., Krumholz B. A. Detection of conditions related to human papillomavirus. Comparison of cytology, colposcopy, histology and hybridization. J Reprod Med. 1990 Jul;35(7):697–703. [PubMed] [Google Scholar]
  43. Syrjänen K., Hakama M., Saarikoski S., Väyrynen M., Yliskoski M., Syrjänen S., Kataja V., Castrén O. Prevalence, incidence, and estimated life-time risk of cervical human papillomavirus infections in a nonselected Finnish female population. Sex Transm Dis. 1990 Jan-Mar;17(1):15–19. [PubMed] [Google Scholar]
  44. Syrjänen K., Väyrynen M., Saarikoski S., Mäntyjärvi R., Parkkinen S., Hippeläinen M., Castren O. Natural history of cervical human papillomavirus (HPV) infections based on prospective follow-up. Br J Obstet Gynaecol. 1985 Nov;92(11):1086–1092. [PubMed] [Google Scholar]
  45. Syrjänen K., Yliskoski M., Kataja V., Hippeläinen M., Syrjänen S., Saarikoski S., Ryhänen A. Prevalence of genital human papillomavirus infections in a mass-screened Finnish female population aged 20-65 years. Int J STD AIDS. 1990 Nov;1(6):410–415. doi: 10.1177/095646249000100604. [DOI] [PubMed] [Google Scholar]
  46. Van Den Brule A. J., Walboomers J. M., Du Maine M., Kenemans P., Meijer C. J. Difference in prevalence of human papillomavirus genotypes in cytomorphologically normal cervical smears is associated with a history of cervical intraepithelial neoplasia. Int J Cancer. 1991 May 30;48(3):404–408. doi: 10.1002/ijc.2910480317. [DOI] [PubMed] [Google Scholar]
  47. Wilbur D. C., Stoler M. H. Testing for human papillomavirus: basic pathobiology of infection, methodologies, and implications for clinical use. Yale J Biol Med. 1991 Mar-Apr;64(2):113–125. [PMC free article] [PubMed] [Google Scholar]
  48. Yliskoski M., Cantell K., Syrjänen K., Syrjänen S. Topical treatment with human leukocyte interferon of HPV 16 infections associated with cervical and vaginal intraepithelial neoplasias. Gynecol Oncol. 1990 Mar;36(3):353–357. doi: 10.1016/0090-8258(90)90141-7. [DOI] [PubMed] [Google Scholar]
  49. Yliskoski M., Saarikoski S., Syrjänen K. Conization for CIN associated with human papillomavirus infection. Arch Gynecol Obstet. 1991;249(2):59–65. doi: 10.1007/BF02390363. [DOI] [PubMed] [Google Scholar]
  50. de Villiers E. M. Laboratory techniques in the investigation of human papillomavirus infection. Genitourin Med. 1992 Feb;68(1):50–54. doi: 10.1136/sti.68.1.50. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. de Villiers E. M., Schneider A., Gross G., zur Hausen H. Analysis of benign and malignant urogenital tumors for human papillomavirus infection by labelling cellular DNA. Med Microbiol Immunol. 1986;174(6):281–286. doi: 10.1007/BF02123680. [DOI] [PubMed] [Google Scholar]
  52. de Villiers E. M., Wagner D., Schneider A., Wesch H., Miklaw H., Wahrendorf J., Papendick U., zur Hausen H. Human papillomavirus infections in women with and without abnormal cervical cytology. Lancet. 1987 Sep 26;2(8561):703–706. doi: 10.1016/s0140-6736(87)91072-5. [DOI] [PubMed] [Google Scholar]

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