[Cervical screening: toward a new paradigm?].
OBJECTIVE
Analysis of the trials which compare the virologic testing (HPV testing) and the cytology in the cervical screening.


METHODS
The MedLine database was consulted using the Keywords: "cervical screening", "pap smear", "liquid based cytology", "HPV testing", "adults", "adolescents", "cervical intraepithelial neoplasia (CIN)", "uterine cervix cancer". Articles were selected according their concern about the debate of the uterine cervix cancer screening in France.


RESULTS
The HPV testing seems interesting allowing a decreasing delay in the diagnosis of CIN (more diagnosis of CIN2+ in the first round and less during the second one). But, when the two rounds are added, the number of CIN2+ are identical in the two arms (cytology and HPV testing) in all the trials (except the Italian NTCC trial). A negative HPV testing protects the women much longer than cytology can do: a delay of five years between two rounds seems ideal. The HPV testing alone increases the detection rate of cervical lesions, which could regress spontaneously and may induce an overtreatment, especially in the youngest population: a triage is necessary and the cytology appears to be the best way to select the candidates for colposcopy in case of positive HPV testing and cytology. The HPV infection presents some particularities in adolescent females: for this reason, the HPV testing should not be used in this special population. In vaccinated women, a consensus for the screening is necessary.


CONCLUSIONS
The health care providers in France have to understand the characteristics of the HPV testing: its advantages compared to the cytologic screening are only evident in case of an organization of the screening in France and even in Europe.
Lavoué
V
V
Service de gynécologie, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France.
Bergeron
C
C
Riethmuller
D
D
Daraï
E
E
Mergui
J-L
JL
Baldauf
J-J
JJ
Gondry
J
J
Douvier
S
S
Lopès
P
P
de Reilhac
P
P
Quéreux
C
C
Letombe
B
B
Marchetta
J
J
Boulanger
J-C
JC
Levêque
J
J
D000293:Adolescent; D000328:Adult; D005060:Europe; D005260:Female; D005602:France; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000821:virology; D053918:Papillomavirus Vaccines; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control* / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000821:virology
D053918:Papillomavirus Vaccines