Screening for cervical cancer: New alternatives and research
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| Formato: | Artículo científico |
| Lenguaje: | en |
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Instituto Nacional de Salud Pública
2003
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| _version_ | 1876427712062554112 |
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| author | Attila T. Lörincz |
| author_facet | Attila T. Lörincz |
| contents | Screening for cervical cancer: New alternatives and research Attila T. Lörincz Salud Mexico screening Papanicolaou cervical cancer human papillomavirus Evidence for the clinical utility of human papillomavirus (HPV)DNA testing has increased over the years and has now becomevery convincing. Some specific uses of HPV detection are a)triage of women with cytological determinations of atypicalsquamous cells of undetermined significance (ASC-US) andrelated management strategies, b) as a marker for test of curepost-treatment, and c) most importantly, as an adjunct tocytology in routine cervical disease screening programs. Thereare many studies that support each of these applications andinclude 8 studies on ASC-US triage, 10 on test of cure and 13on adjunctive or stand-alone HPV screening. The most notableinvestigation of ASC-US triage was ALTS, a randomizedcontrolled trial of 3 488 women. With respect to routine HPVscreening the combined studies included 77 000 women,providing as a histological endpoint more than 1 000 cases ofhigh-grade cervical intraepithelial neoplasia (CIN) or cancer.Testing methods were either the Hybrid Capture 2 (HC2) testor the polymerase chain reaction (PCR) test. HPV testing ofwomen with ASC-US cytology had on average a highersensitivity (90%) and specificity (70%) than repeating thecytological test (sensitivity 75%, specificity 60%) and was alsomore sensitive than colposcopy for follow-up. As an adjunct tothe Papanicolaou (Pap) cytology test in routine screening, HPVDNA testing was a more sensitive indicator for prevalent highgradeCIN than either conventional or liquid cytology. Acombination of HPV DNA and Papanicolaou testing had almost100% sensitivity and negative predictive value. The specificityof the combined tests was slightly lower than the specificity ofthe Papanicolaou test. One double-negative HPV DNA andPapanicolaou test indicated a higher prognostic assuranceagainst risk of future CIN 3 than three subsequent negativeconventional Papanicolaou tests and may safely allow threeyearor longer screening intervals for such low- risk women. It appears that HPV DNA testing is on the way to becoming acommon testing strategy in cervical cancer preventionprograms. Research continues into approaches for improvingthe performance and cost-effectiveness of HPV detectionmethods. Hybrid Capture 3 will offer improved HPV typingcapabilities and the Rapid Capture machine allows for robotassistedHPV DNA testing, permitting greater test throughput.PCR test improvements are expected to contribute to thegrowth of flexible accurate and cost-effective HPV DNA tests.It is likely that improved diagnostic technology along with HPVgenotyping and quantitation may provide more value in future.A particularly promising approach is to combine HPV DNAtesting with expression levels of other markers such asproliferative or cell cycle regulatory proteins to subdivide HPVpositivewomen into those who are at greater risk of cancerand those who can be safely followed by screening at longerintervals. This paper 2003 artículo científico 0036-3634 https://www.redalyc.org/articulo.oa?id=10609712 en http://www.redalyc.org/revista.oa?id=106 Salud Pública de México application/pdf Instituto Nacional de Salud Pública Salud Pública de México (México) Num.3 Vol.45 |
| format | Artículo científico |
| id | redalyc_10609712 |
| institution | Redalyc |
| language | en |
| publishDate | 2003 |
| publisher | Instituto Nacional de Salud Pública |
| spellingShingle | Screening for cervical cancer: New alternatives and research Attila T. Lörincz Salud Mexico screening Papanicolaou cervical cancer human papillomavirus Screening for cervical cancer: New alternatives and research Attila T. Lörincz Salud Mexico screening Papanicolaou cervical cancer human papillomavirus Evidence for the clinical utility of human papillomavirus (HPV)DNA testing has increased over the years and has now becomevery convincing. Some specific uses of HPV detection are a)triage of women with cytological determinations of atypicalsquamous cells of undetermined significance (ASC-US) andrelated management strategies, b) as a marker for test of curepost-treatment, and c) most importantly, as an adjunct tocytology in routine cervical disease screening programs. Thereare many studies that support each of these applications andinclude 8 studies on ASC-US triage, 10 on test of cure and 13on adjunctive or stand-alone HPV screening. The most notableinvestigation of ASC-US triage was ALTS, a randomizedcontrolled trial of 3 488 women. With respect to routine HPVscreening the combined studies included 77 000 women,providing as a histological endpoint more than 1 000 cases ofhigh-grade cervical intraepithelial neoplasia (CIN) or cancer.Testing methods were either the Hybrid Capture 2 (HC2) testor the polymerase chain reaction (PCR) test. HPV testing ofwomen with ASC-US cytology had on average a highersensitivity (90%) and specificity (70%) than repeating thecytological test (sensitivity 75%, specificity 60%) and was alsomore sensitive than colposcopy for follow-up. As an adjunct tothe Papanicolaou (Pap) cytology test in routine screening, HPVDNA testing was a more sensitive indicator for prevalent highgradeCIN than either conventional or liquid cytology. Acombination of HPV DNA and Papanicolaou testing had almost100% sensitivity and negative predictive value. The specificityof the combined tests was slightly lower than the specificity ofthe Papanicolaou test. One double-negative HPV DNA andPapanicolaou test indicated a higher prognostic assuranceagainst risk of future CIN 3 than three subsequent negativeconventional Papanicolaou tests and may safely allow threeyearor longer screening intervals for such low- risk women. It appears that HPV DNA testing is on the way to becoming acommon testing strategy in cervical cancer preventionprograms. Research continues into approaches for improvingthe performance and cost-effectiveness of HPV detectionmethods. Hybrid Capture 3 will offer improved HPV typingcapabilities and the Rapid Capture machine allows for robotassistedHPV DNA testing, permitting greater test throughput.PCR test improvements are expected to contribute to thegrowth of flexible accurate and cost-effective HPV DNA tests.It is likely that improved diagnostic technology along with HPVgenotyping and quantitation may provide more value in future.A particularly promising approach is to combine HPV DNAtesting with expression levels of other markers such asproliferative or cell cycle regulatory proteins to subdivide HPVpositivewomen into those who are at greater risk of cancerand those who can be safely followed by screening at longerintervals. This paper 2003 artículo científico 0036-3634 https://www.redalyc.org/articulo.oa?id=10609712 en http://www.redalyc.org/revista.oa?id=106 Salud Pública de México application/pdf Instituto Nacional de Salud Pública Salud Pública de México (México) Num.3 Vol.45 |
| title | Screening for cervical cancer: New alternatives and research |
| topic | Salud Mexico screening Papanicolaou cervical cancer human papillomavirus |
| url | https://www.redalyc.org/articulo.oa?id=10609712 |