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 Use of High Risk Primary HPV Testing

 
 
"Screening for cervical cancer saves lives and identifies the condition early when it is treatable," says Task Force member Carol Mangione, M.D., M.S.P.H. "There are several effective screening strategies available, so women should talk to their doctor about which one is right for them."
 
Update on Screening for Cervical Cancer  
 
New Guidelines Released  
 
The U.S. Preventive Services Task Force released on Tuesday, 
August 21, 2018, a final recommendation statement on screening for cervical cancer. The Task Force found that women aged 21 to 65 years benefit from screening.
 
  
The Task Force recommends:
  • Every 3 years cervical cytology for women aged
    21 to 29 years*  
      
  • Three strategies to screen women aged 30 to 65 years*: 

       - Cervical cytology every 3 years
                - hrHPV test alone every 5 years   
 
                - Both cytology and hrHPV test (co-testing)
                  every 5 years.    
  
The Task Force recommends against:
  • Screening women younger than 21 years and women older than 65 years who have had adequate prior screening.*
     
  • Screening women of any age who do not have a cervix
    and do not have a history of a high-grade precancerous lesion (ie, cervical intraepithelial neoplasia CIN II or III) or cervical cancer.
* Recommendations apply to individuals who have a cervix, regardless 
of their sexual history or HPV vaccination status. Recommendations do not apply to individuals who have been diagnosed with a high-grade precancerous cervical lesion i.e., cervical intraepithelial neoplasia CIN II or III or cervical cancer. Recommendations also do not apply to individuals with in utero exposure to diethylstilbestrol or those who have a compromised immune system (eg, women living with HIV). 

  
Visit the U.S. Preventive Services Task Force website for the recommendation summary and evidence.  
  
The final recommendation statement can be found in the
August 21 online issue of JAMA.  
 
A New Paradigm in The Fight Against Cervical Cancer

HPV Primary Screening 

According to the ASCCP (American Society for Colposcopy and Cervical Pathology) primary hrHPV screening is an important scientific and clinical advance in cervical cancer screening since it offers better reassurance of low cancer risk compared to cytology-only screening conducted at the same interval.

Now the U.S. Preventive Services Task Force suggests that primary hrHPV screening can be considered as an alternative to current US cytology-based cervical cancer screening approaches including cytology alone and cotesting. The use of HPV 16/18 genotyping and reflex cytology for women positive for the 12 other hrHPV genotypes achieves a reasonable balance of disease detection
with the number of screening tests and colposcopies required to achieve that detection. 

Note in 2016 the FDA gave the go ahead for the first human papillomavirus (HPV) test to be used as primary screening for cervical cancer. This new FDA decision allows one test, the cobas® HPV test (manufactured by Roche), to be used alone for primary cervical cancer screening.* This test detects 12 "high risk" types of HPV while also identifying HPV 16 and 18 specifically, the two types found with approximately 70% of cervical cancers globally. Under the new indication, women who test positive for high risk HPV with cobas® will then have a Pap test, while those positive for the more aggressive HPV 16 and HPV 18 will be referred for colposcopy.      
 
Women should talk to their clinicians to choose which strategy is right for them. The Centers for Disease Control (CDC) and Ladies First will now reimburse for primary HPV testing as a screening strategy for women ages 30-65 years old. 
 
* Currently, the most commonly endorsed HPV test used for primary cervical cancer screening is the FDA-approved Cobas®. Clinicians are advised that other FDA-approved tests for primary screening may be available now or in the future. Reference to Cobas® or any specific commercial product, process, or service by trade name, trademark, or otherwise does not constitute or imply endorsement or recommendation by the Vermont Department of Health or the State of Vermont.
 
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