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
Keywords: HPV testing, cervical screening, systematic review
Full Text
The Full Text of this article is available as a PDF (59.8 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bosch F. X., Manos M. M., Muñoz N., Sherman M., Jansen A. M., Peto J., Schiffman M. H., Moreno V., Kurman R., Shah K. V. Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group. J Natl Cancer Inst. 1995 Jun 7;87(11):796–802. doi: 10.1093/jnci/87.11.796. [DOI] [PubMed] [Google Scholar]
- Burger M. P., Hollema H., Pieters W. J., Schröder F. P., Quint W. G. Epidemiological evidence of cervical intraepithelial neoplasia without the presence of human papillomavirus. Br J Cancer. 1996 Mar;73(6):831–836. doi: 10.1038/bjc.1996.146. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Clavel C., Masure M., Bory J. P., Putaud I., Mangeonjean C., Lorenzato M., Gabriel R., Quereux C., Birembaut P. Hybrid Capture II-based human papillomavirus detection, a sensitive test to detect in routine high-grade cervical lesions: a preliminary study on 1518 women. Br J Cancer. 1999 Jul;80(9):1306–1311. doi: 10.1038/sj.bjc.6690523. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cox J. T., Lorincz A. T., Schiffman M. H., Sherman M. E., Cullen A., Kurman R. J. Human papillomavirus testing by hybrid capture appears to be useful in triaging women with a cytologic diagnosis of atypical squamous cells of undetermined significance. Am J Obstet Gynecol. 1995 Mar;172(3):946–954. doi: 10.1016/0002-9378(95)90026-8. [DOI] [PubMed] [Google Scholar]
- Cuzick J., Beverley E., Ho L., Terry G., Sapper H., Mielzynska I., Lorincz A., Chan W. K., Krausz T., Soutter P. HPV testing in primary screening of older women. Br J Cancer. 1999 Oct;81(3):554–558. doi: 10.1038/sj.bjc.6690730. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cuzick J., Sasieni P., Davies P., Adams J., Normand C., Frater A., van Ballegooijen M., van den Akker E. A systematic review of the role of human papillomavirus testing within a cervical screening programme. Health Technol Assess. 1999;3(14):i-iv, 1-196. [PubMed] [Google Scholar]
- Cuzick J., Szarewski A., Terry G., Ho L., Hanby A., Maddox P., Anderson M., Kocjan G., Steele S. T., Guillebaud J. Human papillomavirus testing in primary cervical screening. Lancet. 1995 Jun 17;345(8964):1533–1536. doi: 10.1016/s0140-6736(95)91086-7. [DOI] [PubMed] [Google Scholar]
- Cuzick J., Terry G., Ho L., Monaghan J., Lopes A., Clarkson P., Duncan I. Association between high-risk HPV types, HLA DRB1* and DQB1* alleles and cervical cancer in British women. Br J Cancer. 2000 Apr;82(7):1348–1352. doi: 10.1054/bjoc.1999.1103. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dillner J., Lehtinen M., Björge T., Luostarinen T., Youngman L., Jellum E., Koskela P., Gislefoss R. E., Hallmans G., Paavonen J. Prospective seroepidemiologic study of human papillomavirus infection as a risk factor for invasive cervical cancer. J Natl Cancer Inst. 1997 Sep 3;89(17):1293–1299. doi: 10.1093/jnci/89.17.1293. [DOI] [PubMed] [Google Scholar]
- Dong Y. L., Gangula P. R., Fang L., Wimalawansa S. J., Yallampalli C. Uterine relaxation responses to calcitonin gene-related peptide and calcitonin gene-related peptide receptors decreased during labor in rats. Am J Obstet Gynecol. 1998 Aug;179(2):497–506. doi: 10.1016/s0002-9378(98)70386-2. [DOI] [PubMed] [Google Scholar]
- Habbema J. D., van Oortmarssen G. J., Lubbe J. T., van der Maas P. J. The MISCAN simulation program for the evaluation of screening for disease. Comput Methods Programs Biomed. 1985 May;20(1):79–93. doi: 10.1016/0169-2607(85)90048-3. [DOI] [PubMed] [Google Scholar]
- Herrero R., Hildesheim A., Bratti C., Sherman M. E., Hutchinson M., Morales J., Balmaceda I., Greenberg M. D., Alfaro M., Burk R. D. Population-based study of human papillomavirus infection and cervical neoplasia in rural Costa Rica. J Natl Cancer Inst. 2000 Mar 15;92(6):464–474. doi: 10.1093/jnci/92.6.464. [DOI] [PubMed] [Google Scholar]
- Herrington C. S., Evans M. F., Hallam N. F., Charnock F. M., Gray W., McGee J. D. Human papillomavirus status in the prediction of high-grade cervical intraepithelial neoplasia in patients with persistent low-grade cervical cytological abnormalities. Br J Cancer. 1995 Jan;71(1):206–209. doi: 10.1038/bjc.1995.42. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ho G. Y., Burk R. D., Klein S., Kadish A. S., Chang C. J., Palan P., Basu J., Tachezy R., Lewis R., Romney S. Persistent genital human papillomavirus infection as a risk factor for persistent cervical dysplasia. J Natl Cancer Inst. 1995 Sep 20;87(18):1365–1371. doi: 10.1093/jnci/87.18.1365. [DOI] [PubMed] [Google Scholar]
- Kjaer S. K., Brinton L. A. Adenocarcinomas of the uterine cervix: the epidemiology of an increasing problem. Epidemiol Rev. 1993;15(2):486–498. doi: 10.1093/oxfordjournals.epirev.a036131. [DOI] [PubMed] [Google Scholar]
- Krüger-Kjaer S., van den Brule A. J., Svare E. I., Engholm G., Sherman M. E., Poll P. A., Walboomers J. M., Bock J. E., Meijer C. J. Different risk factor patterns for high-grade and low-grade intraepithelial lesions on the cervix among HPV-positive and HPV-negative young women. Int J Cancer. 1998 May 29;76(5):613–619. doi: 10.1002/(sici)1097-0215(19980529)76:5<613::aid-ijc1>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
- Lehtinen M., Dillner J., Knekt P., Luostarinen T., Aromaa A., Kirnbauer R., Koskela P., Paavonen J., Peto R., Schiller J. T. Serologically diagnosed infection with human papillomavirus type 16 and risk for subsequent development of cervical carcinoma: nested case-control study. BMJ. 1996 Mar 2;312(7030):537–539. doi: 10.1136/bmj.312.7030.537. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Manos M. M., Kinney W. K., Hurley L. B., Sherman M. E., Shieh-Ngai J., Kurman R. J., Ransley J. E., Fetterman B. J., Hartinger J. S., McIntosh K. M. Identifying women with cervical neoplasia: using human papillomavirus DNA testing for equivocal Papanicolaou results. JAMA. 1999 May 5;281(17):1605–1610. doi: 10.1001/jama.281.17.1605. [DOI] [PubMed] [Google Scholar]
- Nobbenhuis M. A., Walboomers J. M., Helmerhorst T. J., Rozendaal L., Remmink A. J., Risse E. K., van der Linden H. C., Voorhorst F. J., Kenemans P., Meijer C. J. Relation of human papillomavirus status to cervical lesions and consequences for cervical-cancer screening: a prospective study. Lancet. 1999 Jul 3;354(9172):20–25. doi: 10.1016/S0140-6736(98)12490-X. [DOI] [PubMed] [Google Scholar]
- Olsen A. O., Gjøen K., Sauer T., Orstavik I., Naess O., Kierulf K., Sponland G., Magnus P. Human papillomavirus and cervical intraepithelial neoplasia grade II-III: a population-based case-control study. Int J Cancer. 1995 May 4;61(3):312–315. doi: 10.1002/ijc.2910610306. [DOI] [PubMed] [Google Scholar]
- Peyton C. L., Schiffman M., Lörincz A. T., Hunt W. C., Mielzynska I., Bratti C., Eaton S., Hildesheim A., Morera L. A., Rodriguez A. C. Comparison of PCR- and hybrid capture-based human papillomavirus detection systems using multiple cervical specimen collection strategies. J Clin Microbiol. 1998 Nov;36(11):3248–3254. doi: 10.1128/jcm.36.11.3248-3254.1998. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Raffle A. E., Alden B., Mackenzie E. F. Detection rates for abnormal cervical smears: what are we screening for? Lancet. 1995 Jun 10;345(8963):1469–1473. doi: 10.1016/s0140-6736(95)91036-0. [DOI] [PubMed] [Google Scholar]
- 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]
- Remmink A. J., Walboomers J. M., Helmerhorst T. J., Voorhorst F. J., Rozendaal L., Risse E. K., Meijer C. J., Kenemans P. The presence of persistent high-risk HPV genotypes in dysplastic cervical lesions is associated with progressive disease: natural history up to 36 months. Int J Cancer. 1995 May 4;61(3):306–311. doi: 10.1002/ijc.2910610305. [DOI] [PubMed] [Google Scholar]
- Sasieni P. D., Cuzick J., Lynch-Farmery E. Estimating the efficacy of screening by auditing smear histories of women with and without cervical cancer. The National Co-ordinating Network for Cervical Screening Working Group. Br J Cancer. 1996 Apr;73(8):1001–1005. doi: 10.1038/bjc.1996.196. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sasieni P., Cuzick J., Farmery E. Accelerated decline in cervical cancer mortality in England and Wales. Lancet. 1995 Dec 9;346(8989):1566–1567. doi: 10.1016/s0140-6736(95)92099-4. [DOI] [PubMed] [Google Scholar]
- Shafi M. I. Management of women with mild dyskaryosis. Cytological surveillance avoids overtreatment. BMJ. 1994 Sep 3;309(6954):590–591. doi: 10.1136/bmj.309.6954.590. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Vizcaino A. P., Moreno V., Bosch F. X., Muñoz N., Barros-Dios X. M., Parkin D. M. International trends in the incidence of cervical cancer: I. Adenocarcinoma and adenosquamous cell carcinomas. Int J Cancer. 1998 Feb 9;75(4):536–545. doi: 10.1002/(sici)1097-0215(19980209)75:4<536::aid-ijc8>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
- Walboomers J. M., Jacobs M. V., Manos M. M., Bosch F. X., Kummer J. A., Shah K. V., Snijders P. J., Peto J., Meijer C. J., Muñoz N. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999 Sep;189(1):12–19. doi: 10.1002/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F. [DOI] [PubMed] [Google Scholar]
- Walboomers J. M., de Roda Husman A. M., Snijders P. J., Stel H. V., Risse E. K., Helmerhorst T. J., Voorhorst F. J., Meijer C. J. Human papillomavirus in false negative archival cervical smears: implications for screening for cervical cancer. J Clin Pathol. 1995 Aug;48(8):728–732. doi: 10.1136/jcp.48.8.728. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wright T. C., Jr, Denny L., Kuhn L., Pollack A., Lorincz A. HPV DNA testing of self-collected vaginal samples compared with cytologic screening to detect cervical cancer. JAMA. 2000 Jan 5;283(1):81–86. doi: 10.1001/jama.283.1.81. [DOI] [PubMed] [Google Scholar]
- de Roda Husman A. M., Snijders P. J., Stel H. V., van den Brule A. J., Meijer C. J., Walboomers J. M. Processing of long-stored archival cervical smears for human papillomavirus detection by the polymerase chain reaction. Br J Cancer. 1995 Aug;72(2):412–417. doi: 10.1038/bjc.1995.347. [DOI] [PMC free article] [PubMed] [Google Scholar]
