BRIEF REPORT |
Correspondence to: Mark H. Stoler, Pathology, University of Virginia Health System, Jefferson Park Ave., OMS Room 3880, PO Box 800214, Charlottesville, VA 22908.
![]() |
Summary |
---|
![]() ![]() ![]() ![]() |
---|
Based on the best estimates of the prevalence of human Papillomavirus infection in the United States, the overall HPV prevalence in the target population is approximately 20%. The prevalence varies greatly with age, being as high as 50% in the third decade to less than 5% in the sixth. These data have implications for a discussion about the utility of human Papillomavirus testing as a screening procedure.
(J Histochem Cytochem 49:11971198, 2001)
Key Words: human, Papillomavirus, screening, cervical neoplasia, Pap smear
![]() |
Introduction |
---|
![]() ![]() ![]() ![]() |
---|
It is clear that Pap smear screening has been very effective. It is equally clear that virtually all lesions encompassed by the term "cervical neoplasia" are HPV-associated. The epidemiological and molecular evidence supporting this is convincing. Epidemiological studies demonstrate that a positive HPV test is the most powerful independent risk factor for the development of both cervical dysplasia and invasive cancer. Once HPV status is accounted for, the relative risk associated with traditional factors such as sexual behavior becomes insignificant. In limited studies, HPV infection precedes and predicts for the development of cervical pre-cancer as well as invasive cancer. Furthermore, 93100% of invasive carcinomas from around the world have been shown to be associated with a limited spectrum of HPV types (
As noted above, molecular technologies continue to evolve rapidly. The next-generation Hybrid Capture test (HC2) is relatively semi-automated, uses a microtiter format, and has up to 50 times the analytic sensitivity of the present test. Whether or not the improved sensitivity is of clinical benefit greatly depends on whether one is using the test for screening vs diagnosis and the population characteristics. The interplay among sensitivity, specificity, and disease prevalence must be constantly kept in mind when the utility of any test is evaluated. Likewise, PCR/amplification technologies are rapidly evolving. In addition, the expanding sequence database of all relevant human papillomaviruses make it likely that the new, powerful DNA-chip technologies may possibly replace or augment current HPV testing methods (
Might HPV testing be a better screening method? This question has been most thoroughly examined by workers in the Netherlands, who have proposed using an extremely sensitive PCR-based method as the first step in a cervical cancer screening program (
![]() |
Footnotes |
---|
Presented in part at the Joint Meeting of the Histochemical Society and the International Society for Analytical and Molecular Morphology, Santa Fe, NM, February 27, 2001.
Received for publication January 19, 2001; accepted February 16, 2001.
![]() |
Literature Cited |
---|
![]() ![]() ![]() ![]() |
---|
ALTS Group (2000) Human papillomavirus testing for triage of women with cytologic evidence of low-grade squamous intraepithelial lesions: baseline data from a randomized trial. J Natl Cancer Inst 92:397-402
Manos MM, Kinney WK, Hurley LB, Sherman ME, ShiehNgai J, Kurman RJ, Ransley JE, Fettermann BJ, Hartinger JS, McIntosh KM, Pawlick GF, Hiatt RA (1999) Identifying women with cervical neoplasia: using human papillomavirus DNA testing for equivocal Papanicolaou results. JAMA 281:1605-1610
Schiffman M, Adrianza ME (2000) ASCUS-LSIL Triage Study. Design, methods and characteristics of trial participants. Acta Cytol 44:726-742[Medline]
Schiffman M, Herrero R, Hildesheim A, Sherman ME, Bratti M, Wacholder S, Alfaro M, Hutchinson M, Morales J, Greenberg MD, Lorincz AT (2000) HPV DNA testing in cervical cancer screening: results from women in a high-risk province of Costa Rica. JAMA 283:87-93
Solomon D, Schiffman M, Tarone RE (2001) Comparison of HPV testing, repeat cytology and immediate colposcopy in ASCUS Triage: baseline results from a randomized trial (ALTS). J Natl Cancer Inst 93:293-299
Stoler MH (2000a) Advances in cervical screening technology. Mod Pathol 13:275-284[Medline]
Stoler MH (2000b) Human papillomaviruses and cervical neoplasia: a model for carcinogenesis. Int J Gynecol Pathol 19:16-28[Medline]
van Ballegooijen M, van den Akkervan Marle ME, Warmerdam PG, Meijer CJ, Walboomers JM, Habbema JD (1997) Present evidence on the value of HPV testing for cervical cancer screening: a model-based exploration of the cost-effectiveness. Br J Cancer 76:651-657[Medline]