Cervical cancer screening: on the way to a shift from cytology to full molecular screening.
Cytology-based nation-wide cervical screening has led to a substantial reduction of the incidence of cervical cancer in western countries. However, the sensitivity of cytology for the detection of high-grade precursor lesions or cervical cancer is limited; therefore, repeated testing is necessary to achieve program effectiveness. Additionally, adenocarcinomas and its precursors are often missed by cytology. Consequently, there is a need for a better screening test. The insight that infection with high-risk human papillomavirus (hrHPV) is the causal agent of cervical cancer and its precursors has led to the development of molecular tests for the detection of hrHPV. Strong evidence now supports the use of hrHPV testing in the prevention of cervical cancer. In this review, we will discuss the arguments in favor of, and concerns on aspects of implementation of hrHPV testing in primary cervical cancer screening, such as the age to start hrHPV-based screening, ways to increase screening attendance, requirements for candidate hrHPV tests to be used, and triage algorithms for screen-positive women.
Department of Pathology, VU University Medical Center, Amsterdam.
M G
MG
Dijkstra
P J F
PJ
Snijders
M
M
Arbyn
D C
DC
Rijkaart
J
J
Berkhof
C J L M
CJ
Meijer
D003581:Cytodiagnosis; D004279:DNA, Viral / Q000235:genetics; D055088:Early Detection of Cancer; D005260:Female; D060005:Genotyping Techniques; D052162:Human papillomavirus 16 / Q000235:genetics; D006801:Humans; D008403:Mass Screening; D025202:Molecular Diagnostic Techniques; D030361:Papillomavirus Infections / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000517:prevention & control / Q000821:virology
D004279:DNA, Viral
cervical cancer screening; hrHPV DNA; self-sampling; triage