title: Approaches for triaging women who test positive for human papillomavirus in cervical cancer screening.
abstract: Substantial evidence exists to support the introduction of molecular testing for human papillomavirus (HPV) as the primary technology in cervical cancer screening. While HPV testing is much more sensitive than cytology for detection of high-grade precancerous lesions, it is less specific. To improve efficiency, it is therefore recommended that a specific test (like cytology) be used in triaging HPV positive women to colposcopy. A number of studies have been conducted that support the use of cytology alone or in conjunction with HPV genotyping for triage. The decision to incorporate genotyping also depends on the commercial HPV test that is selected since not all tests provide results for certain individual high-risk types. Regardless of whether policy officials decide to adopt a triage approach that incorporates genotyping, the use of liquid based cytology (LBC) may also improve screening performance by reducing diagnostic delays. With LBC, the same cell suspension from a single collection may be used for HPV testing and a smear can be immediately prepared if HPV status is positive. This was a critical lesson from a community based demonstration project in Montreal (VASCAR study), where conventional cytology exists and specimen co-collection was not permitted for ethical reasons, requiring HPV positive women to return for an additional screening visit prior to colposcopy.
authors.affiliation: Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Rockville, MD, United States; Department of Oncology, McGill University, Montréal, Québec, Canada. Electronic address: joseph.tota@nih.gov.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Tota
authors.affiliation: Department of Obstetrics & Gynecology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Bentley
authors.affiliation: Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Blake
authors.affiliation: Département de microbiologie et infectiologie, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Coutlée
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Máire A
authors.initials: MA
authors.lastname: Duggan
authors.affiliation: Departments of Pathology, Obstetrics & Gynecology, McGill University, Montréal, Québec, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Ferenczy
authors.affiliation: Department of Oncology, McGill University, Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
authors.affiliation: Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Fung-Kee-Fung
authors.affiliation: Departments of Oncology, Obstetrics & Gynecology, McGill University, Montréal, Québec, Canada.
authors.forename: Walter
authors.initials: W
authors.lastname: Gotlieb
authors.affiliation: Département d'obstétrique-gynécologie et Médecine Sociale et Préventive, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Mayrand
authors.affiliation: Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.
authors.forename: Meg
authors.initials: M
authors.lastname: McLachlin
authors.affiliation: Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Joan
authors.initials: J
authors.lastname: Murphy
authors.affiliation: Departments of Family Practice, Obstetrics & Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Gina
authors.initials: G
authors.lastname: Ogilvie
authors.affiliation: Department of Oncology, McGill University, Montréal, Québec, Canada; Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
authors.forename: Sam
authors.initials: S
authors.lastname: Ratnam
mesh_terms: D000328:Adult; D000368:Aged; D003127:Colposcopy; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D012017:Referral and Consultation; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*
keywords: Cervical cancer; HPV testing; Screening; Triage