Human papillomavirus testing and genotyping in cervical screening

Abstract

Mass vaccination against human papillomavirus (HPV) genotypes 16 and 18 will, in the long term, reduce the incidence of cervical cancer, but screening will remain an important cancer control measure in both vaccinated and unvaccinated women. Since the 1960s, cytology screening has helped to reduce the incidence of cervical cancer, but has a low sensitivity for high-grade cervical intraepithelial neoplasia (CIN) and requires frequent testing. Several HPV tests have become available commercially. They appear to be more sensitive for high-grade CIN, and may further reduce the incidence of cervical cancer compared with cytology. However, they are associated with an increased frequency of positive tests without underlying CIN, and therefore increase the need for colposcopy and repeated testing. This problem will pose a major challenge for switching from cytology-based to HPV-based screening. The aim of this article is to discuss the role and the use of HPV tests and HPV genotyping in unvaccinated women.

Keywords::

• cervical cancer
• CIN
• cytology
• HPV assays
• HPV genotyping
• screening

Financial & competing interests disclosure

The authors have been supported by funding from the Danish Strategic Research Council (case number: 10-092793). The authors are currently undertaking a comparative study of new-generation HPV tests, involving collaboration with Roche Diagnostics A/S, Genomica SAU, Qiagen Gaithersburg Ltd and GenProbe Inc. Elsebeth Lynge has served as an unpaid scientific advisor to GenProbe and Norchip. Jesper Bonde has served as an unpaid scientific advisor to Genprobe, Roche, Qiagen and Genomica. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.