TABLE I.
Uncertainties surrounding implementation of testing for the human papilloma virus (hpv) as the primary cervical cancer screening test
| Question | Reasonable options or possibilities being explored (non-exhaustive list) |
|---|---|
| What is the best age to start screening with hpv testing?a | 25, 30,b or >30 years |
| What is the best age to stop screening with hpv testing?a | 60, 65,b 70, or >70 years |
| What triage test or tests should be used to guide colposcopy referrals after a positive hpv test?a | Pap cytology,b hpv 16 or 16 and 18 genotyping,b hpv E6/E7 messenger RNA testing, methylation (and consequent silencing) of host and viral genes, or p16INK4a staining |
| What is the most appropriate interval for hpv screening tests?a | 5,b 7, 10, >10 years |
| Should we expect hpv testing to become more affordable or cost-effective in the future? | Yes, because of market expansion and high-volume testing if adopted for primary screening |
| Is reliance on industry (hpv test manufacturers) an important concern? | Yes, because of clear commercial and financial interests that might not be in line with the public’s best interests |
a
Question directly related to the development of cervical cancer screening algorithms.
b
Approach recommended in screening guidelines or currently the most widely accepted.