Current status of- & innovations in cervical cancer screening

The main innovation in cervical cancer screening is the switch from cervical cytology to HR-HPV testing as a preliminary screen (as a rule out test). An important attribute of HR-HPV is that because it is more sensitive than cervical cytology for cervical precancer and cancer, it permits a safe extension of screening intervals among the negatives, which then results in less harm due to screening and potentially lower costs.

Essentially, by using HR-HPV testing to first screen the population; it permits a shift from performing frequent cervical cytology testing on all women, to performing cervical cytology testing on just those who have the necessary cause of cervical cancer, HR-HPV. The innovation is the extending of intervals, so rather than screen every 1, 2 or 3 years by cervical cytology you can extend to 5, 6 or 7 years with HR-HPV, and what has started to happen, and will happen over the next year, is that there will be guidelines from various national and international organizations recommending HR-HPV testing. The EU is going to recommend HR testing, some other international bodies will also recommend HR testing, the USA has already recommended HPV and cytology ‘cotesting’ every 5 years, but I believe that may eventually change to HPV testing alone every 3–5 years. So that is the real innovation, that we are shifting the screening from doing routine cervical cytology on everybody at a high frequency, to doing cervical cytology among HPV-positive women who have the necessary cause for cervical cancer. Through doing so, one can potentially save money, clinical visits (which is also money) and manpower.

Ideally women who are low risk and don’t have the causal factor will be screened infrequently, which is common sense; the focus and effort will be on those who have the causal factor. It may seem obvious, but until we had the tools and until they were clinically validated, this was just a theoretical discussion. Now, with these assays becoming readily available, we can shift priorities and resources to HPV-positive women.

This exert has been taken from "An interview with Philip Castle: Current status and future trends in cervical cancer screening" (Future Science Group, December 2013).
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