Options for triage and implications for colposcopists within European HPV-based cervical screening programmes

Area of Science:

• Gynecology
• Oncology
• Public Health

Background:

• Human papillomavirus (HPV)-based screening aims to reduce cervical cancer incidence and mortality.
• Current HPV screening identifies more high-risk HPV (hrHPV) positive women than cytology, particularly younger individuals.
• Effective triage strategies are needed to manage hrHPV positive women, distinguishing those requiring immediate colposcopy from those needing repeat testing.

Purpose of the Study:

• To review and compare triage methods for hrHPV positive tests in cervical cancer screening.
• To evaluate the performance and cost-effectiveness of various triage strategies, including cytology, HPV partial genotyping, dual-staining, and DNA methylation.
• To assess the effectiveness of triage combinations within European HPV-based screening programs.

Main Methods:

• Literature review of publications and manual search from 2010.
• Analysis of studies reporting on cytology, HPV partial genotyping, dual-staining, and DNA methylation for triage.
• Comparative performance evaluation of single and combined triage methods.
• Consideration of cost-effectiveness and triage algorithm structures.

Main Results:

• Partial genotyping for HPV 16 and 18 combined with dual-staining showed the highest risk identification for cervical intraepithelial neoplasia grade three or worse in hrHPV positive populations.
• This combination strategy was also found to be cost-effective in a separate study.
• Publications were challenging to compare objectively due to varying methodologies.

Conclusions:

• Combination triage strategies, particularly involving cytology, HPV partial genotyping, or dual-staining, appear most efficient for current HPV-based cervical cancer screening.
• HPV vaccination may influence the future performance of partial genotyping.
• DNA methylation presents a potential future triage option.