Adding Human Papillomavirus Testing to Cytology for Primary Cervical Cancer Screening: Shooting First and Asking Questions Later
Authors: George F. Sawaya
Journal: Annals of Internal Medicine (2008)

Editorials1 April 2008Adding Human Papillomavirus Testing to Cytology for Primary Cervical Cancer Screening: Shooting First and Asking Questions LaterGeorge F. Sawaya, MDGeorge F. Sawaya, MDFrom San Francisco General Hospital, University of California, San Francisco, CA 94143-0856.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-7-200804010-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Annual cervical cancer screening is a well-established and highly effective routine practice in the United States (1), but it is also inefficient and expensive (2). A more streamlined approach would be to stratify women by risk and adjust the frequency of screening accordingly: Screen low-risk women infrequently, thereby minimizing the harms of screening, while focusing attention and resources on those at higher risk. Because oncogenic types of human papillomavirus (HPV) cause cervical neoplasia, HPV testing is a prime candidate to risk-stratify women for screening.Several different HPV tests are used worldwide, but in the United States, the only commercially available ...References1. Saint M, Gildengorin G, Sawaya GF. Current cervical neoplasia screening practices of obstetrician/gynecologists in the US. Am J Obstet Gynecol. 2005;192:414-21. [PMID: 15695980] CrossrefMedlineGoogle Scholar2. Kulasingam SL, Myers ER, Lawson HW, McConnell KJ, Kerlikowske K, Melnikow J, et al. Cost-effectiveness of extending cervical cancer screening intervals among women with prior normal pap tests. Obstet Gynecol. 2006;107:321-8. [PMID: 16449119] CrossrefMedlineGoogle Scholar3. U.S. Preventive Services Task Force. Cervical cancer screening. Rockville, MD: Agency for Healthcare Research and Quality; 2003. Accessed at www.ahrq.gov/clinic/uspstf/uspscerv.htm on 24 February 2008. Google Scholar4. Saslow D, Runowicz CD, Solomon D, Moscicki AB, Smith RA, Eyre HJ, et al; American Cancer Society. American Cancer Society guideline for the early detection of cervical neoplasia and cancer. CA Cancer J Clin. 2002;52:342-62. [PMID: 12469763] CrossrefMedlineGoogle Scholar5. American College of Obstetricians and Gynecologists. ACOG practice bulletin. Cervical Cytology screening. Number 45, August 2003. Int J Gynaecol Obstet. 2003;83:237-47. [PMID: 14631934] MedlineGoogle Scholar6. Wright TC, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D; for the 2006 ASCCP-Sponsored Consensus Conference. 2006 consensus guidelines for the management of women with abnormal cervical screening tests. J Low Genit Tract Dis. 2007;11:201-22. [PMID: 17917566] CrossrefMedlineGoogle Scholar7. Mayrand MH, Duarte-Franco E, Coutlée F, Rodrigues I, Walter SD, Ratnam S, et al; CCCaST Study Group. Randomized controlled trial of human papillomavirus testing versus Pap cytology in the primary screening for cervical cancer precursors: design, methods and preliminary accrual results of the Canadian cervical cancer screening trial (CCCaST). Int J Cancer. 2006;119:615-23. [PMID: 16572425] CrossrefMedlineGoogle Scholar8. Ronco G, Segnan N, Giorgi-Rossi P, Zappa M, Casadei GP, Carozzi F, et al; New Technologies for Cervical Cancer Working Group. Human papillomavirus testing and liquid-based cytology: results at recruitment from the new technologies for cervical cancer randomized, controlled trial. J Natl Cancer Inst. 2006;98:765-74. [PMID: 16757701] CrossrefMedlineGoogle Scholar9. Datta SD, Koutsky LA, Ratelle S, Unger ER, Shlay J, McClain T, et al. Human papillomavirus infection and cervical cytology in women screened for cervical cancer in the United States, 2003–2005. Ann Intern Med. 2008;148:493-500. LinkGoogle Scholar10. Castle PE, Solomon D, Schiffman M, Wheeler CM. Human papillomavirus type 16 infections and 2-year absolute risk of cervical precancer in women with equivocal or mild cytologic abnormalities. J Natl Cancer Inst. 2005;97:1066-71. [PMID: 16030304] CrossrefMedlineGoogle Scholar11. Hybrid Capture 2 package insert. Gaithersburg, MD: Digene Corporation; 2002. Accessed at www.fda.gov/cdrh/pdf/P890064s009c.pdf on 29 February 2008. Google Scholar12. Castle PE, Schiffman M, Burk RD, Wacholder S, Hildesheim A, Herrero R, et al. Restricted cross-reactivity of hybrid capture 2 with nononcogenic human papillomavirus types. Cancer Epidemiol Biomarkers Prev. 2002;11:1394-9. [PMID: 12433717] MedlineGoogle Scholar13. Sawaya GF, McConnell KJ, Kulasingam SL, Lawson HW, Kerlikowske K, Melnikow J, et al. Risk of cervical cancer associated with extending the interval between cervical-cancer screenings. N Engl J Med. 2003;349:1501-9. [PMID: 14561792] CrossrefMedlineGoogle Scholar14. Sawaya GF, Sung HY, Kinney W, Kearney KA, Miller MG, Hiatt RA. Cervical cancer after multiple negative cytologic tests in long-term members of a prepaid health plan. Acta Cytol. 2005;49:391-7. [PMID: 16124168] CrossrefMedlineGoogle Scholar15. Kitchener HC, Almonte M, Wheeler P, Desai M, Gilham C, Bailey A, et al; ARTISTIC Trial Study Group. HPV testing in routine cervical screening: cross sectional data from the ARTISTIC trial. Br J Cancer. 2006;95:56-61. [PMID: 16773068] CrossrefMedlineGoogle Scholar16. Anttila A, Hakama M, Kotaniemi-Talonen L, Nieminen P. Alternative technologies in cervical cancer screening: a randomised evaluation trial. BMC Public Health. 2006;6:252. [PMID: 17042938] CrossrefMedlineGoogle Scholar17. Cuzick J, Mayrand MH, Ronco G, Snijders P, Wardle J. Chapter 10: new dimensions in cervical cancer screening. Vaccine. 2006;24 Suppl 3 S90-7. [PMID: 16950022] CrossrefMedlineGoogle Scholar18. Cuzick J, Clavel C, Petry KU, Meijer CJ, Hoyer H, Ratnam S, et al. Overview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer. 2006;119:1095-101. [PMID: 16586444] CrossrefMedlineGoogle Scholar19. Wright TC, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ. ASCCP-Sponsored Consensus Conference. 2001 Consensus Guidelines for the management of women with cervical cytological abnormalities. JAMA. 2002;287:2120-9. [PMID: 11966387] CrossrefMedlineGoogle Scholar20. Sawaya GF. A 21-year-old woman with atypical squamous cells of undetermined significance. JAMA. 2005;294:2210-8. [PMID: 16264163] CrossrefMedlineGoogle Scholar21. Maissi E, Marteau TM, Hankins M, Moss S, Legood R, Gray A. The psychological impact of human papillomavirus testing in women with borderline or mildly dyskaryotic cervical smear test results: 6-month follow-up. Br J Cancer. 2005;92:990-4. [PMID: 15785734] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: George F. Sawaya, MDAffiliations: From San Francisco General Hospital, University of California, San Francisco, CA 94143-0856.Disclosures:Grants received: Agency for Healthcare Research and Quality (related to use of HPV DNA testing and cytology). Other: Dr. Sawaya is a co-investigator on a National Institutes of Health–funded study on Hybrid Capture 2 testing and cytology after treatment of cervical intraepithelial neoplasia.Corresponding Author: George F. Sawaya, MD, Colposcopy Clinic, San Francisco General Hospital, University of California, San Francisco, 3333 California Street, Suite 335, San Francisco, CA 94143-0856. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHuman Papillomavirus Infection and Cervical Cytology in Women Screened for Cervical Cancer in the United States, 2003–2005 S. Deblina Datta , Laura A. Koutsky , Sylvie Ratelle , Elizabeth R. 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Denberg, MD, PhD, and Amir Qaseem, MD, PhD, MHA, for the Clinical Guidelines Committee of the American College of Physicians*High-risk human papillomavirus among HIV-infected women with normal cervical cytology: a pilot study in Jos, NigeriaDirect Human Papillomavirus E6 Whole-Cell Enzyme-Linked Immunosorbent Assay for Objective Measurement of E6 Oncoproteins in Cytology SamplesHuman Papillomavirus and Pap SmearTriaging Pap cytology negative, HPV positive cervical cancer screening results with p16/Ki-67 Dual-stained cytologyCommon Abnormal Results of Pap and Human Papillomavirus CotestingUn nouveau paradigme pour le dépistage du cancer du col utérin ?Five-Year Experience of Human Papillomavirus DNA and Papanicolaou Test CotestingInfectie met Humaan papillomavirus (HPV) en cervix cytologie bij vrouwen die gescreend zijn op cervix kanker in de Verenigde Staten tussen 2003 en 2005A Comparison of Linear Array and Hybrid Capture 2 for Detection of Carcinogenic Human Papillomavirus and Cervical Precancer in ASCUS-LSIL Triage Study 1 April 2008Volume 148, Issue 7Page: 557-559KeywordsAntibodiesAtypical squamous cells of uncertain significanceCancer screeningCell biologyCervical cancer screeningDNAGenetic testingHuman papillomavirusLesionsResearch laboratories ePublished: 1 April 2008 Issue Published: 1 April 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. 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