March 29, 2012
Read this March 2012 document for a summary of the key HPV trials that have published results or are underway
This document explores HPV testing’s potential impacts on screening, follow-up practices and future planning. Only the trials that evaluate the use of HPV testing for primary screening have been considered.
HPV testing has been proposed for other purposes, including the follow-up of abnormal Pap test results and monitoring of patients treated for precancerous lesions. The panel did not address those uses of HPV testing.
Cervical screening with the Pap test has effectively decreased both the rate of cervical cancer and the number of cervical cancer deaths in Canada over the past fifty years. However, single-test sensitivity is quite low at around 55 per cent.
The causal role of human papilloma virus (HPV) in cervical cancer is now well established and has led to scientific inquiry into whether there is a role for HPV testing as a primary screening test, potentially replacing the Pap test.
Several large randomized trials comparing Pap testing to HPV testing for primary screening have published results in recent years for one round of screening. Some trial results are reported after two rounds of screening. The outcomes evaluated by the trials include the detection of pre-cancerous cervical lesions (CIN2 or CIN3) as well as cancerous cervical lesions. No trials carried out in Canadian-like settings have evaluated the impact of HPV testing on cervical cancer deaths.
While the trials’ design and protocols vary considerably, the overall findings do indicate that after one round of screening, using the HPV test results in a higher detection rate for pre-cancerous lesions (CIN2 or CIN3) compared to the Pap test.