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By Amy Brower
11/09/07
Approximately 10 million screening tests for the oncogenic strains of Human Papillomavirus (HPV) are performed each year in the United States. This translates into one in four of the women who are candidates for testing actually receiving it. Experts anticipate HPV testing volumes will increase annually, and laboratories are making plans for implementation of HPV screening and genotyping of specific high-risk strains of HPV.
Clinical guidelines play an important role in defining how HPV testing is implemented nationwide. To facilitate this implementation, the American Society of Colposcopy and Cervical Pathology (ASCCP) published consensus guidelines in 2001 and recently updated these guidelines to reflect an increased understanding of the relationship between HPV and cervical cancer. ASCCP convened a group of 146 key opinion leaders from affiliated professional societies and federal and international organizations and conducted an evidence-based review of all available information regarding HPV testing and cervical cancer(1). This international group’s efforts resulted in new consensus guidelines available at http://www.asccp.org/consensus.shtml.
Several findings and recommendations guide HPV testing and are summarized in the following table.
| Finding |
Recommendation |
- Women negative for cytology & HPV testing have less than 1 in 1000 risk of developing precancer (CIN2)
- 3-year screening using combination cytology & HPV testing provides equal or better benefits
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- Women who are negative by cytology & HPV testing should not be screened before 3 years
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- The risk of having precancer (CIN2) is quite low, ranging from 2.4% to 5.1% in cytology-negative, HPV-positive women
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- Women who are cytology negative & HPV positive should have repeat screening at 1 year
- Women who on repeat testing are HPV positive should be referred for colposcopy
- Women who on repeat testing are HPV negative should be screened in 3 years
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- Oncogenic HPV types 16 and 18 may be an important indicator of precancer risk
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- Genotyping for HPV types 16 and 18 in cytology-negative, HPV-positive women is reasonable
- An FDA approved assay is needed
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- Lack of clinical utility in testing for nononcogenic HPV types
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- Testing for low-risk or nononcogenic HPV types is not recommended
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The goal of these national guidelines is to provide timely information to direct HPV testing and prevent cervical cancer. Many of our colleagues in laboratory medicine are leading key studies that assess the utility of these updated recommendations and include the use of new technologies for HPV screening and genotyping. Two such studies, originating in Canada and Sweden, were published recently in the New England Journal of Medicine and found that HPV testing has greater sensitivity for the detection of precancer and reduces the incidence of precancer or cancer, respectively(2, 3). These studies and others in the pipeline will continue to drive adoption and testing volumes, and laboratory medicine will play a key role in providing accurate and timely HPV screening and genotyping.
References:
- Wright TC, Massad S, Dunton C, Spitzer M, Wilkinson E, Solomon D. 2007. American Journal of Obstetrics & Gynecology. 346-355.
- Mayrand M, Duarte-Franco E, Rodrigues I, Walter S, Hanley J, Ferenczy A, Ratnam S, Coutlee F, Franco E. 2007. New England Journal of Medicine. 357:16;1579-1588.
- Naucler P, Ryd W, Tornberg S, Strand A, Wadell G, Elfgren K, Radberg T, Strander B, Forslund O, Hansson B, Rylander E, Dillner J. 2007. New England Journal of Medicine. 357:16;1589-1597.
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