Cervical cancer screening program and Human Papillomavirus (HPV) testing, part II: Update on HPV primary screening.

Key Findings
 

• HPV testing is more sensitive for precancerous lesions CIN2 and CIN3 than cytology. The downside is that the transversal specificity is lower.
• The protective effect of HPV screening compared to cytology on the incidence of invasive cervical cancer is directly demonstrated in randomized trials.
• No protective effect is demonstrated under 30 years.
• The risk of CIN3+ or invasive cervical cancer after a negative hrHPV DNA test is significantly lower than after a negative Pap smear. This means that screening intervals can be extended safely up to five and more.
• A two-step triage scenario with twice cytology at cutoff ASC-US+ offers a good balance of efficiency (4 to 9 referrals to detect one CIN3+, ~40% of referral) and safety (risk of CIN3+ in triage-negative women of 0.5% to 0.9%).
• For the interpretation of cervical cytology specimen, there is no quality control programme yet.
• In Belgium, an ISO15189 accreditation (including participation in external quality assessments) for high-risk HPV detection in cervicovaginal samples using a molecular method - but not for cytopathology - is mandatory for reimbursement.
• The use of colposcopies in Belgium, with high numbers performed without previous cytology result is not in line with the internationally agreed recommendations, where colposcopies should be used to examine women with abnormal cytology findings.
• Proportions of abnormal cytology results varies widely between laboratories.
• It is unlikely that the introduction of HPV screening would lead to a large increase in confirmation tests in the Belgian context.
• HPV screening every 5 year is a dominant option, compared to current practice of cytology screening every 3 years.