More than just a test result: Molecular screening of Human Papilloma Virus for contemporary management of cervical cancer risk

Extract

Human Papilloma Virus (HPV) is the most common sexually transmitted infection (STI), and currently is the only vaccine-preventable etiology of urogenital disease. As an STI, HPV is an independent risk factor for virtually all cases of cervical cancer and is associated with anogenital and orolabial warts. Importantly, infection with HPV is a necessary factor in the development of squamous cervical neoplasia despite the fact that most infections and dysplastic abnormalities will not progress to malignant transformation.^1-3 Over 100 genotypes of HPV have been identified of which less than 50% are transmitted sexually.⁴ Of the urogenital HPV types, several have been associated directly with the enhanced risk of cervical cancer.⁴ In 2012, updated guidelines for cervical cancer screening were put forth by the US Preventative Services Task Force (USPSTF) and the combined partnership of the American Society for Colposcopy and Cervical Pathology (ASCCP), the American Cancer Society (ACS) and the American Society for Clinical Pathology (ASCP). Collectively these guidelines lengthened the time interval between cervical cancer screens and increased the age to begin screening. These evidence-based recommendations indicate the use of either cytology alone or in combination with an FDA-approved HPV test stratified primarily by age, but also by the interval since last screen and hysterectomy status. Compared to cytological investigation alone, co-testing can more informatively direct the need for and method of treating precancerous lesions by more accurately assessing a woman's risk for developing cancer. This article aims to concisely summarize the current guidelines for managing cervical cancer screening, and…

ABBREVIATIONS: ACS - American Cancer Society, ASCP - American Society for Clinical Pathology, ASCCP - American Society for Colposcopy and Cervical Pathology, ASCUS - atypical squamous cells of undetermined significance, CIN - cervical intraepithelial neoplasia, FDA - Food and Drug Administration, HPV - Human Papilloma Virus, HR-HPV - high-risk HPV, HSIL - high-grade squamous intraepithelial lesions, LSIL - low-grade squamous intraepithelial lesions, MDx - molecular diagnostics, NAAT - nucleic acid amplification test, NPV - negative predictive value, PPV - positive predictive value, STD - sexually transmitted disease, STI - sexually transmitted infection.