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HPV as a primary test in cervical screening

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Human papillomavirus (HPV)

  • high risk (HR) HPV is associated with cervical intraepithelial neoplasia (CIN) and is found in 99.7%(1) of cervical cancer cases
    • high risk HPV (HR-HPV), some subtypes can cause cervical cancer. In particular HPV16 and HPV18

  • persistent infection with HR-HPV is a necessary but insufficient cause of cervical cancer

  • persistent HR-HPV infection increases the risk of women developing cervical cancer

  • transient HR-HPV infection is common

HPV in cervical screening

  • high risk (HR)-HPV testing picks up more cervical abnormalities (more sensitive) than cytology, but more women without abnormalities test positive for HR-HPV (not as specific)

  • women who test negative for HR-HPV have no significant cervical abnormalities (CIN2+) in 99.8% (2) of cases

  • most women with high-grade abnormalities will be identified by HR-HPV testing

  • as the HR-HPV test is more sensitive but less specific than cytology, primary HR-HPV testing coupled with cytology triage offers a more appropriate screening strategy, especially in an HPV-vaccinated population

Primary HR-HPV testing

  • all women aged between 25 and 64 (on routine and early recall) are eligible

  • the cervical sample will be taken as normal

  • the sample will be tested for HR-HPV first

  • samples that are positive for HR-HPV will then be processed for cytological examination (cytology triage)

  • women who are HIV+ will be screened annually with the HR-HPV test in accordance with programme guidelines

Possible results

  • HR-HPV not detected: return to normal recall (3 or 5 years)

  • HR-HPV detected, cytology negative (no abnormal cells): recall 12 months

  • HR-HPV detected, cytology positive (abnormal cells found): refer for colposcopy

  • Inadequate result: repeat in 3 months

Women in follow up

  • Women in follow up for treatment of CIN will be given a 3-year recall if HR-HPV negative 6 months after treatment, and will be referred to colposcopy if HR-HPV positive/any grade of cytology

  • Women in follow up after adequate treatment for CGIN/SMILE will be given a 3-year recall if HR-HPV negative at both 6 and 18 months after treatment

  • Women in follow up for cervical cancer (still with cervix) and CGIN/SMILE (without complete excision margins) will be screened annually with the HR-HPV test (instead of cytology) for 10 years

Reference:

  • Reference:
    • WalboomersJM(1), Jacobs MV, Manos MM, Bosch FX. J Pathol. 1999 Sep;189(1):12-9. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide.
    • Kitchener et al. Lancet Oncol 2009, Ronco et al. Lancet Oncol 2006, Ronco et al. JNCI 2006, Rijkaart et al. Lancet Oncol 2012
    • Public Health England (PHE). Primary High Risk HPV Testing with Cytology Triage. NHS Cervical Screening Programme (Accessed March 5th 2019)

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