Promising strategies for cervical cancer screening in the post-human papillomavirus vaccination era

被引:20
作者
Tota, Joseph [1 ,2 ]
Mahmud, Salaheddin M. [1 ,3 ,8 ]
Ferenczy, Alex [4 ,5 ,6 ]
Coutlee, Francois [1 ,7 ]
Franco, Eduardo L. [1 ,2 ]
机构
[1] McGill Univ, Dept Oncol, Montreal, PQ H2W 1S6, Canada
[2] McGill Univ, Dept Epidemiol & Biostat, Montreal, PQ H2W 1S6, Canada
[3] McGill Univ, Dept Surg, Montreal, PQ H2W 1S6, Canada
[4] McGill Univ, Dept Pathol, Montreal, PQ H2W 1S6, Canada
[5] McGill Univ, Dept Obstet & Gynecol, Montreal, PQ H2W 1S6, Canada
[6] McGill Univ, Jewish Gen Hosp, Dept Pathol, Montreal, PQ H3T 1E2, Canada
[7] Ctr Hosp Univ Montreal, Dept Microbiol & Infectiol, Montreal, PQ H2L 4M1, Canada
[8] Univ Manitoba, Dept Community Hlth Sci, Winnipeg, MB R3E 0W3, Canada
基金
加拿大健康研究院;
关键词
cytology; HPV DNA; Pap smear; RANDOMIZED CONTROLLED-TRIAL; COST-EFFECTIVENESS; FOLLOW-UP; CONVENTIONAL CYTOLOGY; WOMEN; DNA; HEALTH; AGE; IMPLEMENTATION; RECRUITMENT;
D O I
10.1071/SH10022
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Human papillomavirus (HPV) vaccination is expected to reduce the burden of cervical cancer in most settings; however, it is also expected to interfere with the effectiveness of screening. In the future, maintaining Pap cytology as the primary cervical screening test may become too costly. As the prevalence of cervical dysplasias decreases, the positive predictive value of the Pap test will also decrease, and, as a result, more women will be referred for unnecessary diagnostic procedures and follow-up. HPV DNA testing has recently emerged as the most likely candidate to replace cytology for primary screening. It is less prone to human error and much more sensitive than the Pap smear in detecting high-grade cervical lesions. Incorporating this test would improve the overall quality of screening programs and allow spacing out screening tests, while maintaining safety and lowering costs. Although HPV testing is less specific than Pap cytology, this issue could be resolved by reserving the latter for the more labour-efficient task of triaging HPV-positive cases. Because most HPV-positive smears would contain relevant abnormalities, Pap cytology would be expected to perform with sufficient accuracy under these circumstances. HPV Pap triage would also provide a low-cost strategy to monitor long-term vaccine efficacy. Although demonstration projects could start implementing HPV testing as a population screening tool, more research is needed to determine the optimal age to initiate screening, the role of HPV typing and other markers of disease progression, and appropriate follow-up algorithms for HPV-positive and Pap-negative women.
引用
收藏
页码:376 / 382
页数:7
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