HPV HANDBOOK - Zervita

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HPV TESTING AS A SCREENING TEST: THE CASE AGAINSTRegressionMild dysplasia(CIN 1)Moderate dysplasia(CIN 2)Severe dysplasia(CIN 3)ProgressionFigure 1 Mild and moderate dysplasias are more likely to regress than toprogressMelkert et al. 1993 reported a higher prevalence of HPV infection inwomen aged
3: HPV AND CERVICAL CANCER: PUBLIC HEALTH PERSPECTIVESSimilar magnitudes of risk were reported by other US investigators.Koutsky et al. 1992 reported a cumulative risk of 28% for CIN 2 or 3,at 2 years, in those women who were initially HPV-positive, comparedwith 3% for those who were HPV-negative. 12 The risk of developingCIN 2 or 3 was highest for those women infected with HPV 16 orHPV 18.Woodman et al. 2001 confirmed the transitory nature of most HPVinfections in young women, and also showed that cytology mayidentify abnormalities after a remarkably short period from the firstevidence of HPV infection. 13Sensitivity of the Pap smearSensitivitySensitivity: the probability that a test will be positive, given thatthe individual being tested has the diseaseThe low correlation between positive HPV testing and abnormalcytology seen in studies of women in whom HPV tests of Pap smearsamples have been carried out, is almost certainly due to the HPV testdetecting mainly non-progressive lesions. 14,15 Although more samplesindicative of women at risk can be recognized by HPV testing, thecorresponding Pap smear will often demonstrate normal or mildlyabnormal cytology. For ideal programme planning, a test should beaccurate enough to distinguish between lesions that will progress andlesions that will regress. Despite the low sensitivity of Pap smeartesting – around only 50% in some studies 14–16 – evidence fromorganized cytology-based screening programmes indicates thatcytology is equally as likely as HPV testing to detect lesions thatprogress. This hypothesis is supported by the success of a 5-yearlyscreening programme in Finland. 1738
Page 4 and 5: THE HEALTH PROFESSIONAL’SHPV HAND
Page 6: ContentsList of contributors 7Intro
Page 10: Introduction to the HPV Handbook se
Page 13 and 14: 3: HPV AND CERVICAL CANCER: PUBLIC
Page 26 and 27: 2. HPV testing as a screeningtest:
Page 28 and 29: HPV TESTING AS A SCREENING TEST: TH
Page 36 and 37: 3. HPV testing as a screeningtest:
Page 44: HPV TESTING AS A SCREENING TEST: TH
Page 66 and 67: THE POTENTIAL PUBLIC HEALTH IMPACT
Page 80 and 81: Indexadenocarcinoma,detection by HP
Page 82 and 83: INDEXuse in ASCUS 53use to confirm

HPV HANDBOOK - Zervita

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