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Screening

Cervical cancer—should we abandon cytology for screening?

Nature Reviews Clinical Oncology volume 9, pages 558559 (2012) | Download Citation

Convincing data have shown that human papillomavirus (HPV)-DNA testing predicts the development of high-grade cervical cancer better than cytology. However, for HPV-positive women, triage with cytology testing should be performed before colposcopy. The question on how to proceed if the cytology test in HPV-positive women is negative remains unclear.

Key points

  • Cervical cancer screening should be done by HPV-DNA testing alone

  • Cytology or cytology with HPV 16 and HPV18 genotyping can be used to triage HPV-positive women for colposcopy

  • The exact algorithm to be used for triage depends on the quality of cytology and the minimum positive predictive value for CIN3+ referral acceptable by local health decision makers

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    et al. Efficacy of HPV DNA testing with cytology triage and/or repeat HPV DNA testing in primary cervical cancer screening. J. Natl Cancer. Inst. 101, 88–99 (2009).

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    et al. Performance of carcinogenic human papillomavirus (HPV) testing and HPV16 or HPV18 genotyping for cervical cancer screening of women aged 25 years and older: a subanalysis of the ATHENA study. Lancet Oncol. 12, 880–890 (2011).

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    et al. Triaging Pap cytology negative, HPV positive cervical cancer screening results with p16/Ki-67 Dual-stained cytology. Gynecol. Oncol. 121, 505–509 (2011).

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    et al. Combined promoter methylation analysis of CADM1 and MAL: an objective triage tool for high-risk human papillomavirus DNA-positive women. Clin. Cancer Res. 17, 2459–2465 (2011).

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    et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am. J. Clin. Pathol. 137, 516–542 (2012).

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Author information

Affiliations

  1. Departments of Pathology and Epidemiology and Biostatistics, Vrije Universiteit, University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands

    • Chris J. L. M. Meijer
    •  & Johannes Berkhof

Authors

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Competing interests

C. J. L. M. Meijer has acted as consultant for Qiagen, GlaxoSmithKline and Merck; has received honoraria from Qiagen and Roche; has received research support from Abbott; is a stockholder in Self-Screen; and holds a patent with MDxHealth. J. Berkhof has received honoraria from Qiagen.

Corresponding author

Correspondence to Chris J. L. M. Meijer.

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DOI

https://doi.org/10.1038/nrclinonc.2012.161

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