The document discusses HPV primary screening for cervical cytology, highlighting its advantages such as improved detection of cervical intraepithelial neoplasia (CIN) in women over 30, potential for extended screening intervals, and cost-effectiveness. It also notes disadvantages, including the need for equipment and varying test sensitivity and specificity, particularly in low-resource settings. Additionally, challenges in accurate cytology triage and public expectations due to false negative rates are outlined.

1. HPV Primary Screening
Cervical Cytology (Up to date, 2016)
Dr Dirk Grothuesmann
http://dg-maternalhealth.de/

2. HPV Primary Screening

3. HPV Primary Screening

4. HPV-DNA Integration into Cellular
Chromatin
Ménage à trois: an evolutionary interplay between human papillomavirus, a tumor, and a woman, Shulzhenko et al,
Vol 22, 6, 345–353, 2014, DOI: http://dx.doi.org/10.1016/j.tim.2014.02.009

5. HPV primary Screening – Advantages
• Improved detection of CIN2+ and CIN3+ in women over 30 years of age in regions
where cytology has not been developed or is suboptimal
• Long-term possibility of increasing the routine screening interval from 3-yearly to
5- or 6-yearly
• Suitable to use alongside self-sampling in low-resource settings
• Likely to be cheaper than cytology in the long run
• Likely to be necessary when prevalence of cervical cancer and its precursors
declines in vaccinated populations

6. HPV primary Screening – Disadvantages
• HPV testing also requires equipment, reagents, training, quality
control and accreditation
• Sensitivity and specificity of different HPV tests is known to vary
• The costs of HPV testing remain too high for low-resource settings

7. HPV primary Screening – Challenges
• Accurate cytology will be needed for triage of HPV+ samples to avoid
false negatives and false positives
• HPV+ women with negative cytology should be tested after 12
months to distinguish persistent from transitory infection
• Long-term follow up of HPV+ women without CIN2+ may be needed
• Public and professional expectations of HPV testing should take
account of its 5-15% false negative rates

8. Sensitivity and Specificity
Sensitivity quantifies the avoiding of FALSE NEGATIVES
Specificity quantifies the avoiding of FALSE POSITIVES
• Sensitivity measures the proportion of positives that are correctly
identified as such (e.g., the percentage of sick people who are
correctly identified as having the condition)
• Specificity measures the proportion of negatives that are correctly
identified as such (e.g., the percentage of healthy people who are
correctly identified as not having the condition)
WKEPEDIA, 2016 from https://en.wikipedia.org/wiki/Sensitivity_and_specificity
Annex

10. http://dg-maternalhealth.de/
Dr Dirk Grothuesmann Consultancy