Diagnosis:
Cervical cancer
Although cytologic testing has been extremely effective in reducing cervical cancer fatality, continued occurrence of cervical cancer in screened populations has led to DNA testing for high oncogenic risk HPVs.
These viruses include HPV 16, 18, 31, and 33, among others. HPV-11 is a low oncogenic risk virus. HPV DNA testing may be performed either as reflex testing of ASCUS (atypical squamous cells of uncertain significance), or as a combined DNA/liquid cytologic screen.
HPV DNA testing is more sensitive and less specific than cytologic testing, with a high negative predictive value and a low positive predictive value. There is no logical indication to test for low oncogenic risk viruses in a screening program.
Mathematical models, using known costs, sensitivity, and specificity of the various tests, and age-specific incidence of cervical cancer, have shown that biennial or triennial testing consisting of cytologic testing plus DNA testing (either dual screen or reflex testing) is more cost effective in women more than 30 years of age, with no reduction in cancer prevention when compared to annual screening strategies.
Because the majority of cancers show HPV 16 or 18, genotyping for these may play a role in the management of cytologic negative HPV positive cases; however, with vaccination for HPV 16 and 18 now standard, this may change.
