Cervical cytology versus primary HPV testing as screening tests for cervical dysplasia

Background: Cervical cancer is the fourth most common cancer among women, accounting for 10% of all female cancers and 7.5% of all cancer deaths worldwide.1,2 Human papillomavirus (HPV) has been detected in up to 99.7% of cervical cancers, making it the primary risk factor for the development of cervical cancer.3 Current guidelines recommend a screening test which includes a combination of cervical cytology as well as HPV co-testing in women over the age of 30, with HPV testing not recommended in women younger than the age of 30.11 The Food and Drug Administration has approved primary HPV testing as a screening test for cervical cancer, however this practice has not yet been adopted by the United States. Continuing to use both methods for screening purposes may lead to discrepant results which can be confusing for both the patient and the provider.12 Objective: To determine the diagnostic efficacy of cervical cytology versus primary HPV testing as screening tests for cervical dysplasia Methods: A Scopus and Pubmed search was conducted using the following search terms and filters: “HPV screening versus cytology NOT home,” “within 5 years,” “full test article” and “English.” Articles were screened and assessed for eligibility based on study design, sample size, year of publication, participant characteristics, and study objectives. Three articles were chosen for review. Conclusion: Primary HPV testing may increase accuracy of referral for colposcopy and therefore cervical intraepithelial neoplasia (CIN2+) diagnoses as compared to cytology. However, these conclusions are based on diagnosis rates after colposcopy referral and therefore do not address possible false-negative screening results in patients who have non-HPV related lesions at the time of screening. Currently, there are also no clinical or pathologic features that may guide clinicians in determining which patients may present with false-negative screening results. Further study can focus on addressing this group of patients that may present with false-negative HPV results at the time of screening.