SIDEBAR: Could HPV Testing Be Used Alone?

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“In the United States, there are no recommendations currently for HPV screening alone as a primary screening test for cervical cancer,” Michael L. LeFevre, MD, MSPH, Co-Vice Chair of the U.S. Preventive Services Task Force (USPSTF) told The ASCO Post. “Cytology picks up very few cases of precancerous lesions that are not found with HPV screening. So it is kind of a fail-safe,” Dr. LeFevre said. Both tests can be done at the same time using the same sample.

“There is limited evidence on the benefits and harms of HPV testing alone as a screening strategy,” the USPSTF noted in its updated guidelines on cervical cancer screening. “An emerging chain of evidence suggests that HPV testing followed by cytology in women with positive HPV test results may also be a reasonable screening strategy. Ongoing studies, such as the HPV Testing for Cervical Cancer Screening (HPV FOCAL) trial, which compares HPV with cytology triage to cytology with HPV triage of test results interpreted as atypical squamous cells of undetermined significance, should provide relevant direct evidence on HPV testing that applies to current U.S. practice.”

Dr. LeFevre remarked, “We look forward to the results of the FOCAL trial, which is going on in Canada. For right now, we don’t recommend HPV testing alone. We recommend co-testing with cytology and HPV as a way to lengthen the interval between the screenings.” Other promising data may emerge from the Population Based Screening Study Amsterdam (POBASCAM) trial in the Netherlands, which also used HPV testing as the primary screening tool and cytology for those who tested positive for HPV. “We might learn more in about 3 to 4 years about other strategies that might cause even less trouble for women who are getting screened and yet could be just as safe,” Dr. LeFevre said. ■

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