HPV testing and vaccination in Europe

Area of Science:

• Gynecology
• Oncology
• Infectious Diseases

Background:

• Current cytology screening for cervical intraepithelial neoplasia grade 3 (CIN 3) and cervical cancer has moderate sensitivity.
• Human papillomavirus (HPV) vaccination and testing are emerging strategies to enhance cervical cancer detection.

Purpose of the Study:

• To evaluate the impact of HPV testing and vaccination on detecting CIN 3 and cervical cancer.
• To assess the effectiveness of HPV testing in various screening scenarios.

Main Methods:

• Review of current cervical screening programs incorporating HPV testing.
• Analysis of HPV testing as a triage for atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions.
• Evaluation of HPV testing as a test of cure and in primary screening.

Main Results:

• HPV testing as a triage for ASCUS demonstrates improved sensitivity and similar specificity compared to cytology for high-grade CIN.
• HPV testing as a test of cure shows higher sensitivity than cytology for persistent cervical precancer.
• HPV-based primary screening is more effective than cytology but requires organized programs to avoid unnecessary referrals.

Conclusions:

• HPV testing offers significant improvements in detecting cervical precancer and cancer, particularly as a triage for ASCUS and as a test of cure.
• Effective implementation of HPV-based screening relies on program organization and adherence to triage algorithms.
• The long-term impact of HPV vaccination on cervical cancer incidence and mortality requires further evaluation over many years.