HPV HANDBOOK - Zervita

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HPV TESTING AS A SCREENING TEST: THE CASE AGAINSTSpecificity issuesSpecificitySpecificity: the probability that a test will be negative, given thatthe individual being tested does not have the diseaseThe specificity of HPV testing is almost invariably found to be lowerthan that of cytology, especially in younger women. 18 Reducing thenumber of false-positive results during screening is particularlyimportant, as they introduce unnecessary investigational costs andinduce anxiety in women. Indeed, it has long been recognized thatfocusing on high sensitivity, to the detriment of low specificity, is apoor strategy for public health purposes. Under circumstances wherethe disease has a long natural history and involves regression, andwhere repeat testing at least every 3 to 5 years is generally envisaged,undue emphasis on high sensitivity at the expense of specificity wouldbe a serious error.OverviewFor women >35 (or preferably >40) years of age with cytologicallynegative smears, HPV testing may prove valuable in confirming thatthey have no evidence of infection with an oncogenic HPV virus. Undersuch circumstances, it is probable that repeat screening would beunnecessary for at least 5 and probably 10 years. An importantrequirement would be that such women should remain in a stablerelationship and that neither they nor their partner should acquire anew HPV infection, otherwise their risk of developing progressive CINwould relapse to the same level as that for a woman aged 35 yearswho is HR HPV-positive.Simply testing for HPV infection, when the great majority of infectionsare transient, makes little sense. Testing for the consequences of suchinfection (i.e. CIN) with cytology is more logical, but only if aconservative approach to management is followed. Therefore,39
3: HPV AND CERVICAL CANCER: PUBLIC HEALTH PERSPECTIVESsurveillance should be initiated for women with cytologic evidence ofborderline or atypical smears (ASCUS: atypical squamous cells ofundetermined significance) and CIN 1. Time is on the clinician’s side,and it is perfectly safe to repeat smears at 6-month intervals for up to2 years if there is no evidence of cytologic progression. In the majorityof cases, regression will occur and referral to colposcopy withunnecessary treatment is avoided. Even those women identified ashaving cytologic evidence of CIN 2 could be followed up by 6-monthlysmears on at least two occasions, because the majority of theselesions will also regress. 6 HPV testing in these circumstances (triage)is able to reveal those with HR HPV infections, but will not help todetermine which cases will progress or regress, so triage with HPVtests is of no help in determining which lesions need to be treated.40
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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