HPV Primary ScreeningCervical Cytology (Up to date,

2016)

Dr Dirk Grothuesmannhttp://dg-maternalhealth.de/

HPV Primary Screening

HPV Primary Screening

 HPV-DNA Integration into Cellular Chromatin 

Ménage à trois: an evolutionary interplay between human papillomavirus, a tumor, and a woman, Shulzhenko et al, Vol 22, 6, 345–353, 2014, DOI: http://dx.doi.org/10.1016/j.tim.2014.02.009

HPV primary Screening – Advantages

• Improved detection of CIN2+ and CIN3+ in women over 30 years of age in regions where cytology has not been developed or is suboptimal

• Long-term possibility of increasing the routine screening interval from 3-yearly to 5- or 6-yearly

• Suitable to use alongside self-sampling in low-resource settings• Likely to be cheaper than cytology in the long run• Likely to be necessary when prevalence of cervical cancer and its precursors

declines in vaccinated populations

HPV primary Screening – Disadvantages

• HPV testing also requires equipment, reagents, training, quality control and accreditation

• Sensitivity and specificity of different HPV tests is known to vary• The costs of HPV testing remain too high for low-resource settings

HPV primary Screening – Challenges

• Accurate cytology will be needed for triage of HPV+ samples to avoid false negatives and false positives

• HPV+ women with negative cytology should be tested after 12 months to distinguish persistent from transitory infection

• Long-term follow up of HPV+ women without CIN2+ may be needed• Public and professional expectations of HPV testing should take

account of its 5-15% false negative rates

Sensitivity and SpecificitySensitivity quantifies the avoiding of FALSE NEGATIVESSpecificity quantifies the avoiding of FALSE POSITIVES

• Sensitivity measures the proportion of positives that are correctly identified as such (e.g., the percentage of sick people who are correctly identified as having the condition)

• Specificity measures the proportion of negatives that are correctly identified as such (e.g., the percentage of healthy people who are correctly identified as not having the condition)

WKEPEDIA, 2016 from https://en.wikipedia.org/wiki/Sensitivity_and_specificity

Annex

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Dr Dirk Grothuesmann Consultancy