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The page below is a sample from the LabCE course Human Papillomavirus (HPV) and Molecular Testing for Cervical Cancer. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Should the HPV Test Be Used as a First-Line Primary Cervical Cancer Screen? (Continued).

In 2018 the guidelines and practice recommendations for cervical cancer screening using HPV testing were updated to include HPV testing alone as the primary screening option.
In August 2018, the USPSTF concluded that there was a high degree of certainty that the benefits of screening every 3 years with cytology alone, every 5 years with hrHPV testing alone, or in combination in women aged 30 to 65 years outweigh the harms. Although HPV testing has been used for many years to help in cervical cancer screening, this is the first time that a national guideline has recommended the sole use of HPV tests for women ages 30-65.
The USPSTF stressed that current evidence indicates that there are no clinically important differences between liquid-based cytology and conventional cytology for cervical cancer screening. In fact, evidence from RCTs have suggested that screening with cytology alone is slightly less sensitive for detecting CIN 2 and CIN3 than screening with hrHPV testing alone. The guidelines do suggest that screening with cytology alone, hrHPV alone and both in combination offer a reasonable balance between benefits and harms for women aged 30-65. Women in this age group should discuss with their health care professional which testing strategy is best for them.
It is important to note the following when discussing the update 2018 guidelines for cervical cancer screening:
  • When the draft of the 2018 USPSTF guidelines were released in late 2017, they did not originally include co-testing as a recommended screening method. However, some clinicians expressed concern for the need of a transition period before HPV is adopted as a primary screening method. Hence, the final 2018 recommendations do include co-testing as an option.
  • The updated guidelines are based on findings from recent studies that demonstrated that testing for high-risk strains of HPV detected a higher rate of precancerous lesions in the cervix as compared with the Pap test alone.
  • Although evidence from RCTs indicates that hrHPV testing and co-testing can detect more cases of CIN 2 and CIN 3, they also have higher false-positive rates compared with cytology alone. Co-testing has the highest false-positive rate. False-positive rates are also higher among women younger than 30 years than among older women because of the higher incidence of transient HPV infection in younger women, even though cervical cancer incidence is lower in this age group.
  • These recommendations are meant for asymptomatic women regardless of sexual history or HPV vaccination status. As in the previous guideline, the USPSTF recommends against screening for average-risk women younger than 21 years, older than 65 years who have had adequate prior screening, or women who have had a hysterectomy with removal of the cervix and do not have a history of high-grade precancerous lesions
Conclusions on HPV test as a first-line primary cervical cancer screen:
There is accumulating clinical evidence that screening with hrHPV alone as the primary cervical cancer screen or using a combination of hrHPV and cytology may offer a reasonable balance between benefits and harms for women aged 30-65. With the recent USPSTF guideline recommendations, we can expect to see an increase use of the hrHPV test as the first-line primary screen for cervical cancer. (We should also expect that women in the recommended age group will certainly discuss with their health care professional which testing strategy is best for them).
For now, it appears that the hrHPV test used alone as the primary cervical cancer screen may be an option for most women aged 30-65!
For more details, please consult the following reference link: Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement: US Preventive Services Task Force, August 21, 2018, JAMA. 2018;320(7), available at https://jamanetwork.com/journals/jama/fullarticle/2697704 ;