A new approach to cervical cancer screening has emerged among healthcare providers determined to further reduce the incidence of cervical cancer: co-testing with Pap cytology and HPV testing (pooled and individual genotyping for HPV types 16 and 16/18) for women 30-65 years of age.
Pap cytology alone has a low degree of sensitivity with a single cycle of screening.1, 2 While sensitivity increases over several cycles, during that time, undetected disease may be progressing. In an overview of over 60,000 women, a single round of HPV testing has been shown to have a sensitivity of about 90% for cervical cancer and its precursor lesions,2 establishing Pap cytology together with HPV testing as superior over cytology alone in detecting precancer and cancer of the cervix.
1 in 10 women who are positive for HPV 16 and/or 18 have high-grade cervical disease that is missed by cytology.3
HPV testing combined with the widespread confidence in Pap cytology gives clinicians a greater opportunity to address precancer risk, and gives women greater certainty and less ambiguity around understanding their risk of cervical cancer. Here is what co-testing could mean for your practice:
A growing body of literature supports the benefits of pooled high-risk HPV (hrHPV) DNA testing when used with Pap cytology in cervical cancer screening of women aged 30 years or older. A large U.S. observational study showed that HPV testing promoted:4
1. The ASCUS-LSIL Triage Study Group. Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance. Am J Obstet Gynecol. 2003;188(6):1383-1392.
2.Cuzick J, Clavel C, Petry K, et al. Overview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer. 2006;119(5):1095-1101.
3.Wright TC Jr, Stoler MH, Sharma A, et al. Evaluation of HPV-16 and HPV-18 genotyping for the triage of women with high-risk HPV+ cytology-negative results. Am J Clin Pathol. 2011;136(4):578-586.
4.Katki HA, Kinney WK, Fetterman B, et al. Cervical cancer risk for women undergoing concurrent human papillomavirus and cervical cytology: a population-based study in routine clinical practice. Lancet Oncol. 2011;12(7):663-672.