scholarly journals Ushering in a new era: human papillomavirus (HPV) testing comes to the NHS Cervical Screening Programme

2011 ◽  
Vol 37 (2) ◽  
pp. 64-67 ◽  
Author(s):  
A. Szarewski
Keyword(s):  
Human Papillomavirus ◽  
Screening Programme ◽  
Cervical Screening ◽  
Hpv Testing ◽  
New Era

Impact of replacing cytology with human papillomavirus testing for cervical cancer screening on the prevalence of Trichomonas vaginalis: a modelling study

2018 ◽  
Vol 94 (3) ◽  
pp. 216-221 ◽  
Author(s):  
Ben B Hui ◽  
Caitlin P Reulein ◽  
Rebecca J Guy ◽  
Basil Donovan ◽  
Jane S Hocking ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Trichomonas Vaginalis ◽  
Screening Programme ◽  
Cervical Screening ◽  
Time Frame ◽  
Hpv Testing ◽  
Hpv Prevalence ◽  
Increased Risk ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition

ObjectivesTrichomonas vaginalis (TV) is the most common curable STI worldwide and is associated with increased risk of HIV acquisition and serious reproductive morbidities. The prevalence of TV infection is very low in Australian cities, and this is thought to be at least partly due to incidental detection and treatment of TV in women participating in the cervical cytology screening programme. In 2017, the national cervical screening programme will transition to a new model based on testing for high-risk (HR) human papillomavirus (HPV), with a reduced frequency and commencement at an older age. We model the potential impact of this transition on TV prevalence in Australia.MethodsA mathematical model was developed to describe the transmission of TV in the general population and used to evaluate scenarios that capture the switch from cytology-based screening to HR HPV testing. Under these scenarios, individuals with asymptomatic TV who test negative for HR HPV will remain undiagnosed and untreated. We estimate the change in TV prevalence expected to occur due to the switch from cytology to HR HPV testing and changes to the frequency and age at commencement of screening.ResultsOur results suggest that with the transition to HR HPV testing, TV prevalence may increase from the current ~0.4% to 2.8% within 20 years if TV testing coverage is not increased and HR HPV prevalence does not decline further. If HR HPV prevalence continues to decline at its current rate with ongoing vaccination, TV prevalence is predicted to increase to 3.0% within this time frame.ConclusionsOur modelling suggests that in a setting like Australia, where TV can be detected incidentally through cytology-based cervical screening, a transition to HPV testing is likely to result in increasing TV prevalence over time unless additional measures are implemented to increase TV testing and treatment.

scholarly journals Clinical impact and cost-effectiveness of primary cytology versus human papillomavirus testing for cervical cancer screening in England

2019 ◽  
Vol 29 (4) ◽  
pp. 669-675
Author(s):  
Irenjeet Bains ◽  
Yoon Hong Choi ◽  
Kate Soldan ◽  
Mark Jit
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Cervical Screening ◽  
Clinical Impact ◽  
Hpv Testing ◽  
Life Years ◽  
The Impact

ObjectivesIn England, human papillomavirus (HPV) testing is to replace cytological screening by 2019–2020. We conducted a model-based economic evaluation to project the long-term clinical impact and cost-effectiveness of routine cytology versus HPV testing.MethodsAn individual-based model of HPV acquisition, natural history, and cervical cancer screening was used to compare cytological screening and HPV testing with cytology triage for women aged 25–64 years (with either 3- or 5-year screening intervals for women aged under 50 years). The model was fitted to data from England's National Health Service Cervical Screening Programme. Both clinical and economic outcomes were projected to inform cost-effectiveness analyses.ResultsHPV testing is likely to decrease annual cytology testing (by 2.76 million), cervical cancer incidence (by 290 cases), and health system costs (by £13 million). It may increase the number of colposcopies, although this could be reduced without leading to more cancers compared with primary cytology by increasing the interval between screens to 5 years. The impact in terms of quality-adjusted life-years (QALYs) depends on the quality of life weight given to colposcopies versus cancer.ConclusionsEngland's move from cytology to HPV screening may potentially be life-saving and cost-effective. Cost-effectiveness can be improved further by extending the interval between screens or using alternative triage methods such as partial or full genotyping.

Promising strategies for cervical cancer screening in the post-human papillomavirus vaccination era

Sexual Health ◽  
2010 ◽  
Vol 7 (3) ◽  
pp. 376 ◽  
Author(s):  
Joseph Tota ◽  
Salaheddin M. Mahmud ◽  
Alex Ferenczy ◽  
François Coutlée ◽  
Eduardo L. Franco
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Human Error ◽  
Pap Smear ◽  
Cervical Screening ◽  
Screening Tests ◽  
Hpv Testing ◽  
Human Papillomavirus Vaccination ◽  
Screening Programs

Human papillomavirus (HPV) vaccination is expected to reduce the burden of cervical cancer in most settings; however, it is also expected to interfere with the effectiveness of screening. In the future, maintaining Pap cytology as the primary cervical screening test may become too costly. As the prevalence of cervical dysplasias decreases, the positive predictive value of the Pap test will also decrease, and, as a result, more women will be referred for unnecessary diagnostic procedures and follow-up. HPV DNA testing has recently emerged as the most likely candidate to replace cytology for primary screening. It is less prone to human error and much more sensitive than the Pap smear in detecting high-grade cervical lesions. Incorporating this test would improve the overall quality of screening programs and allow spacing out screening tests, while maintaining safety and lowering costs. Although HPV testing is less specific than Pap cytology, this issue could be resolved by reserving the latter for the more labour-efficient task of triaging HPV-positive cases. Because most HPV-positive smears would contain relevant abnormalities, Pap cytology would be expected to perform with sufficient accuracy under these circumstances. HPV Pap triage would also provide a low-cost strategy to monitor long-term vaccine efficacy. Although demonstration projects could start implementing HPV testing as a population screening tool, more research is needed to determine the optimal age to initiate screening, the role of HPV typing and other markers of disease progression, and appropriate follow-up algorithms for HPV-positive and Pap-negative women.

scholarly journals Offering self-sampling for human papillomavirus testing to non-attendees of the cervical screening programme: Characteristics of the responders

2012 ◽  
Vol 48 (12) ◽  
pp. 1799-1808 ◽  
Author(s):  
Murat Gök ◽  
Daniëlle A.M. Heideman ◽  
Folkert J. van Kemenade ◽  
Anton L.M. de Vries ◽  
Johannes Berkhof ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Screening Programme ◽  
Cervical Screening ◽  
Human Papillomavirus Testing

Advances in cervical cancer screening and human papillomavirus vaccines

2006 ◽  
Vol 12 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Cynthia Feeley
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Cervical Screening ◽  
Invasive Cervical Cancer ◽  
Hpv Testing ◽  
Industrialized Countries ◽  
Major Health Problem ◽  
Major Health ◽  
Efficiency And Effectiveness ◽  
Overall Efficiency

Cervical cancer is causally linked to human papillomavirus (HPV) and constitutes a major health problem for women. Nearly 80% of the 510,000 cases reported worldwide each year occur in developing countries which lack organized screening programmes. Cervical screening has effectively reduced the incidence of and mortality from invasive cervical cancer in industrialized countries, but is not completely protective. Cervical screening is now undergoing modernization and has seen several changes in recent years. These aim to enhance the overall efficiency and effectiveness of screening, reduce rates of inadequate sampling, increase sensitivity rates and facilitate ancillary technologies, such as HPV testing. This review discusses these advances and the development of HPV vaccines.

scholarly journals Acceptability of self- collection for human papillomavirus detection in the Eastern Cape, South Africa

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241781
Author(s):  
Ongeziwe Taku ◽  
Tracy L. Meiring ◽  
Inger Gustavsson ◽  
Keletso Phohlo ◽  
Mirta Garcia-Jardon ◽  
...  
Keyword(s):  
South Africa ◽  
Human Papillomavirus ◽  
Cervical Screening ◽  
Health Clinic ◽  
Hpv Testing ◽  
Eastern Cape ◽  
Community Based ◽  
Transport Medium ◽  
Fta Cards ◽  
Significant Difference

Human papillomavirus (HPV) testing on vaginal self-collected and cervical clinician-collected specimens shows comparable performance. Self-sampling on FTA cards is suitable for women residing in rural settings or not attending regular screening and increases participation rate in the cervical cancer screening programme. We aimed to investigate and compare high-risk (HR)-HPV prevalence in clinician-collected and self-collected genital specimens as well as two different HPV tests on the clinician collected samples. A total of 737 women were recruited from two sites, a community health clinic (n = 413) and a referral clinic (n = 324) in the Eastern Cape Province. Cervical clinician-collected (FTA cards and Digene transport medium) and vaginal self-collected specimens were tested for HR-HPV using the hpVIR assay (FTA cards) and Hybrid Capture-2 (Digene transport medium). There was no significant difference in HR-HPV positivity between clinician-collected and self-collected specimens among women from the community-based clinic (26.4% vs 27.9%, p = 0.601) or the referral clinic (83.6% vs 79.9%, p = 0.222). HPV16, HPV35, and HPV33/52/58 group were the most frequently detected genotypes at both study sites. Self-sampling for HPV testing received a high positive response of acceptance (77.2% in the community-based clinic and 83.0% in referral clinic). The overall agreement between hpVIR assay and HC-2 was 87.7% (k = 0.754). The study found good agreement between clinician-collected and self-collected genital specimens. Self-collection can have a positive impact on a cervical screening program in South Africa by increasing coverage of women in rural areas, in particular those unable to visit the clinics and women attending clinics where cytology-based programs are not functioning effectively.

scholarly journals Randomised trial of HPV self-sampling among non-attenders in the Slovenian cervical screening programme ZORA: comparing three different screening approaches

2018 ◽  
Vol 52 (4) ◽  
pp. 399-412 ◽  
Author(s):  
Urska Ivanus ◽  
Tine Jerman ◽  
Alenka Repse Fokter ◽  
Iztok Takac ◽  
Veronika Kloboves Prevodnik ◽  
...  
Keyword(s):  
Screening Programme ◽  
Cervical Screening ◽  
Randomised Trial ◽  
Intraepithelial Neoplasia ◽  
Response Rates ◽  
Risk Difference ◽  
Control Group ◽  
Hpv Testing ◽  
Opt Out ◽  
Screening Approaches

Abstract Background To overcome obstacles within the Slovenian organised cervical cancer screening programme, a randomised pilot study of human papillomavirus (HPV) self-sampling among non-attenders was performed, aiming to assess three different screening approaches. Participants and methods Non-attenders aged 30–64 years from two Slovenian regions were randomised to two HPV self-sampling groups–the opt-in (I1, n = 14.400) and the opt-out (I2, n = 9.556), with a control group (P, n = 2.600). Self-collected samples were analysed using the Hybrid Capture 2 assay. HPV-positive women were invited to a colposcopy. The overall and type-specific intention-to-screen response rates and histological outcomes with a positive predictive value (PPV) according to the women’s age, the screening approach, the level of protection resulting from previous screening history, and the region of residence were assessed. Results Of the 26.556 women enrolled, 8.972 (33.8%) responded with self-sample for HPV testing and/or traditional cytology within one year of enrolment. Response rates were 37.7%, 34.0% and 18.4% (p < 0.050) for opt-out, opt-in and control groups. Cervical intraepithelial neoplasia (CIN)2+ was diagnosed in 3.9/1.000, 3.4/1.000, and 3.1/1.000 women (p > 0.050), respectively. PPV of the HPV self-sampling was 12.0% and 9.6% for CIN2+ and CIN3+. The highest PPV was obtained in non-attenders in screening programme for more than 10-years and concordant results of HPV testing with 40.8% for CIN2+ and 38.8% for CIN3+. Conclusions The results of our study show that a high response to HPV self-sampling can be achieved also in an opt-in approach, if women are encouraged to choose between self-sampling at home and screening with gynaecologist. In addition, clinically important risk difference for a high-grade cervical lesion exists in the case of a positive result of HPV testing on self-collected samples, depending on the length of the interval since last screening. Stratified management of these women should be strongly considered. Women who were not screened with cytology for at least 10 years should be referred to immediate colposcopy for histology verification instead to delayed re-testing.

scholarly journals HPV testing compared with routine cytology in cervical screening: long-term follow-up of ARTISTIC RCT

2019 ◽  
Vol 23 (28) ◽  
pp. 1-44 ◽  
Author(s):  
Clare Gilham ◽  
Alexandra Sargent ◽  
Henry C Kitchener ◽  
Julian Peto
Keyword(s):  
Human Papillomavirus ◽  
Cervical Screening ◽  
Hpv Infection ◽  
Cancer Registration ◽  
Hpv Testing ◽  
Cervical Intraepithelial Neoplasia Grade ◽  
Normal Cytology ◽  
Hpv Test ◽  
Hpv Screening

Background The National Screening Committee (NSC) based its recommendation that human papillomavirus (HPV) testing should replace cytology in primary cervical screening largely on the 2009 follow-up results of the ARTISTIC trial (A Randomised Trial In Screening To Improve Cytology). The NSC must now decide on screening intervals and triage policy. Options include extending the screening interval up to 10 years for human papillomavirus-negative (HPV–) women, delaying recall for human papillomavirus-positive (HPV+) women with normal cytology (as their infections are usually transient), and basing triage on full HPV typing. Methods In ARTISTIC, 24,510 women were recruited who were attending routine cervical cytology in Greater Manchester in 2001–3. The women were randomly allocated between revealing and concealing their HPV test results and were recalled every 3 years. After 2009, the women returned to routine cytological screening with recall every 3 years for those aged < 50 years, and every 5 years for those aged 50–64 years. We have followed the cohort to 2015 through national cancer registration for CIN3 (cervical intraepithelial neoplasia grade 3) and cancer, and through linkage to the cervical screening call–recall system to obtain lifetime cytology records. Results The analysis comprised 24,496 women at round 1 and 13,591 women at round 2 (which was 30–48 months later). Follow-up via local histology laboratories and national cancer registration identified 505 cases of cervical intraepithelial neoplasia grade 3 or cervical cancer (CIN3+) (including 22 invasive cervical cancers). The cumulative CIN3+ risk 10 years after a negative HPV test [0.31%, 95% confidence interval (CI) 0.18% to 0.49%, in the revealed arm] was similar to that 3 years after negative cytology (0.30%, 95% CI 0.23% to 0.41%, in the concealed arm) and fell sharply with age, from 1.1% (95% CI 0.7% to 1.8%) in those women aged < 25 years to 0.08% (95% CI 0.03% to 0.20%) in those women aged > 50 years. The 10-year cumulative CIN3+ risk following a new HPV infection at round 2 was 3.4% (95% CI 2.1% to 5.4%). The highest risks were associated with type-specific persistent infections that, overall, resulted in a 10-year cumulative CIN3+ risk of 20.4% (95% CI 15.6% to 26.4%). Conclusions We found a similar level of protection 10 years after a negative HPV test and 3 years after negative cytology. These data support a considerably longer screening interval after a negative HPV test than after a negative cytology test. About three-quarters of women with HPV infection and normal cytology clear their infections within about 3 years. Their risk of CIN3+ within this time frame is low (1.5%), suggesting that the current policy of annual repeat testing and referral after 2 years may be unnecessarily cautious. Approximately 40% of women who remained HPV+ had cleared their initial infection and acquired a new HPV type. The cumulative CIN3+ risks in women with type-specific persistent infections are about six times higher than in women with new infections. Triage strategies based on HPV persistence would, therefore, reduce unnecessary referral of women with new (and largely transient) infections. HPV assays that identify HPV types 31, 33, 45, 52 and 58 in addition to 16 and 18 could be useful in triage as well as in primary HPV testing. Similar results in recent routine HPV screening suggest that our results are generalisable despite changes in cytology and HPV assay methods. We are continuing to follow the ARTISTIC cohort into the new era of primary HPV screening. Future work will focus on the implications of more sensitive HPV testing for primary HPV screening policy and triage of HPV-positive women. Our results suggest that a more sensitive test is needed to detect occult CIN3 at high risk of progression to cancer, but this would substantially increase the overall HPV detection rate. Tests such as DNA (deoxyribonucleic acid) methylation for distinguishing HPV infection from neoplasia will be evaluated on stored samples and on further samples now being collected from women in the cohort who are still being screened. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 28. See the NIHR Journals Library website for further project information.

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