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Chapter 13: Primary Screening of Cervical Cancer With Human Papillomavirus Tests
Open accessAbstract
Despite its history of success in cancer screening, Pap cytology has important limitations, particularly its high false-negative rate, which carries important public health implications. Since the mid-1990s, there has been substantial interest in the use of human papillomavirus (HPV) DNA testing in cervical cancer screening under the premise that the testing of cervical cells for the causative agent of cervical cancer could have acceptable screening performance, while being more reproducible in clinical practice than Pap cytology. There have been several studies assessing the utility of HPV testing compared with the Pap test as a screening tool. These studies varied widely in lesion-outcome definition and in methodology. No studies were based on cervical cancer incidence or mortality. No randomized controlled trials have yet been published; all of the studies were based on concomitant testing for HPV and cytology or additional tests. HPV testing has greater sensitivity (average, 27%) but somewhat lower specificity (average, 8%) than Pap cytology for detecting high-grade lesions. Screening of women aged 30 years or older tends to improve test specificity, but it also does so for cytology. The combination of cytology and HPV attained high-negative predictive values, which suggests that their joint use could allow screening intervals to be safely increased, thus lowering costs. Although evidence is yet to come from long-term studies and from randomized controlled trials with high-grade lesions and invasive cancer as outcomes, HPV testing is clearly one of the most promising new technologies and has the potential to improve cervical cancer-screening effectiveness in many settings.
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There is a gradual adoption of HPV testing in many developed as well as developing countries.
“Currently, there is interest in more widespread use of VIA in lowresource settings, 27 and there is a gradual adoption of HPV testing in many developed as well as developing countries.10”
From A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India (2005) · cites this paper as [10]
HPV testing is more sensitive than cytology at identifying CIN2/3 lesions but with lower specificity.
“Studies, particularly in developed countries, suggest that HPV testing is more sensitive than cytology at identifying CIN 2=3 lesions but with lower specificity.10,[20][21][22][23][24][25]”
From A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India (2005) · cites this paper as [10]
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Khanna, N., Mishra, S., Tian, G., Tan, M. T., Arnold, S. J., Lee, C., Ramachandran, S., Bell, L., Baquet, C. R., & Lorincz, A. T. (2007) · International Journal of Gynecological Cancer · doi:10.1111/j.1525-1438.2006.00835.x · Cited by 25
Optimizing technology for cervical cancer screening in high-resource settings
Richardson, L., Tota, J. E., & Franco, E. L. (2011) · Expert Review of Obstetrics & Gynecology · doi:10.1586/eog.11.13 · Cited by 22
Self-citationIsidean, S. D., Coutlée, F., & Franco, E. L. (2013) · Expert Review of Molecular Diagnostics · doi:10.1586/14737159.2014.865521 · Cited by 23
Self-citationCerigo, H., Coutlée, F., Franco, E. L., & Brassard, P. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-438 · Cited by 22
Self-citationNgan, H., Garland, S. M., Bhatla, N., Pagliusi, S. R., Chan, K. K. L., Cheung, A., Chu, T., Domingo, E. J., Qiao, Y., Park, J. S., et al. (2011) · Journal of Cancer Epidemiology · doi:10.1155/2011/794861 · Cited by 22
Olusegun, A. K., Adepiti, C. A., Okunola, T. O., Go, O.-E., & Onwundiegu, U. (2017) · Journal of Cytology · doi:10.4103/joc.joc_199_15 · Cited by 22
Report of the 2003 Pan-Canadian Forum on Cervical Cancer Prevention and Control
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Duncan, L. D., Jacob, S. V., & Hubbard, E. W. (2008) · Cancer · doi:10.1002/cncr.23255 · Cited by 21
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Integrating Human Papillomavirus Vaccination in Cervical Cancer Control Programmes
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Worldwide Burden of Gynecological Cancer
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Are we ready for a paradigm change in cervical cancer screening?
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Epidemiology of Cervical, Vulvar, and Vaginal Cancers
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Metadata
- Authors
- Franco, E. L.
- Affiliations
- McGill University (CA)
- Corresponding author
- Franco, E. L.
- ORCID
- Franco, E. L.
- Venue
- JNCI Monographs
- Publisher
- Oxford University Press (OUP)
- Published
- 2003-06-01
- Volume
- 2003
- Issue
- 31
- Pages
- 89-96
- ISSN
- 1052-6773 (ISSN-L)
- 1745-6614
- OpenAlex
- W2135253681
- Cited by
- 146
- References
- 28
- Citations by year
- 2026: 2 · 2022: 4 · 2021: 2 · 2019: 4 · 2018: 4 · 2017: 3 · 2016: 5 · 2015: 2 · 2014: 6 · 2013: 6 · 2012: 10
- FWCI
- 11.78
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- Locations
- JNCI Monographs (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Keywords
- cervical cancer screening, HPV testing, Pap smear cytology, primary screening, false negative rate, high-grade cervical lesions, sensitivity and specificity, negative predictive value, screening interval extension, cost reduction
- MeSH terms
- Uterine Cervical Neoplasms, DNA, Viral, Ethics, Medical, Female, Humans, Mass Screening, Primary Prevention, Public Health, Sensitivity and Specificity, Tumor Virus Infections, Vaginal Smears, Observer Variation, Polymerase Chain Reaction, Ethics, Clinical, Papillomaviridae, Papillomavirus Infections, Ethics, Research
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