Role of HPV Testing and HPV Typing in Cervical Cancer Prevention and Detection

Nearly 50 percent of lesions missed by a single Pap test cytology screen may be detected by additional testing for oncogenic Human Papillomavirus (HPV) infection. HPV testing for carcinogenic HPV types is commonly used in the United States to triage equivocal Pap test diagnoses for referral for further examination by colposcopy. HPV testing is also widely accepted as a co-test for primary screening of women over 30, since women without carcinogenic HPV infection are at extremely low risk for clinically relevant cervical disease for many years.

In addition, recent studies suggest that HPV testing alone may be a reasonable alternative to Pap smear alone for cervical cancer screening. HPV-based screening seems to promote earlier identification of women at high risk of cervical cancer and, in one recently presented study, safely extended three-year screening intervals for this population. It remains unclear at this time what combination of HPV testing, Pap smear, or co-testing with HPV and Pap represents the optimal screening strategy. The Society of Gynecologic Oncology (SGO) encourages additional study of this issue and remains part of the team of cancer care professionals vested in establishing appropriate screening guidelines.

HPV typing for the most common types of the disease, HPV 16 and HPV 18, is also available for clinical use. SGO believes that HPV testing and typing should be viewed as important, additional diagnostic and screening tools, however:

• These tests should not replace other cervical cancer screening methods, including regular Pap tests and gynecologic examinations. This recommendation may change, depending on current clinical practices and the enhancement of guidelines for the use of both HPV testing and HPV typing.
• HPV testing and HPV typing should not be used as a prescreening tool for HPV vaccination. It is SGO’s position that, because positive or negative oncogenic HPV testing or HPV 16/18 typing is not helpful in determining those who would clinically benefit from HPV vaccination and would add unnecessary additional costs, identifying the presence of HPV infection should not be used as a prescreening tool for HPV vaccination.