Co-Testing: Pap-Test and mRNA HPV-Test for Cervical Cancer Screening

Co-Testing: Pap-Test and mRNA HPV-Test for Cervical Cancer Screening

Maria Halatsi (Diagnostics Department, Aenorasis, Athens, Greece), Evripidis Bilirakis (Hellenic Society of Cervical Pathology and Colposcopy, Greece & IASO Medical Center, Athens, Greece), Stamatios Petousis (2nd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Greece), Εleftherios Vavoulidis (2nd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Greece) and Konstantinos Dinas (2nd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Greece)
DOI: 10.4018/978-1-7998-4213-2.ch008

Abstract

The dramatic decline in cervical cancer in women is attributable first to screening with the Papanicolaou (Pap) test, followed later by the addition of the Human Papilloma Virus (HPV) test, which enhanced screening sensitivity. In association with this excellent performance record, resulting from the combination of Pap Test and HPV Test, known also as Co-Testing, the current standard of care for cervical cancer screening for most women (those over 30) is Co-Testing with Pap + HPV tests, as currently recommended by U.S. guidelines. The challenge is to improve screening cost-effectiveness without compromising efficacy. The notion that screening with one test may be more cost-effective than two tests seems reasonable upon first consideration, but closer examination may dispute this assumption. The chapter aims to analyze costs and benefits regarding optimal screening method for daily clinical practice.
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Introduction

The dramatic decline in cervical cancer in women is attributable first to screening with the Papanicolaou (Pap) test, followed later by the addition of the human papilloma virus (HPV) test, which enhanced screening sensitivity (International Agency for Research on Cancer [IARC], 2012; Schiffman & Solomon, 2007, 2013).

In keeping with this excellent performance record resulting from the combination of Pap Test and HPV Test, known also as Co-Testing, the current standard of care for cervical cancer screening for most women (those over 30), as currently recommended by U.S. guidelines, is Co-Testing with Pap Test + HPV test (Massad et al., 2013; Saslow et al., 2012).

In 2014, the Food and Drug Administration (FDA) approved an HPV assay to be used alone as a primary screening test, initiating a debate about what is the best way to detect cancer (U.S. Food & Drug Administration [FDA], 2014).

It is advocated by the scientific community that to more fully investigate the potential benefits of HPV-only screening, HPV-only test results must be compared with cotest results in the detection and prevention of invasive cervical cancer in real-world clinical practice with clinical populations that are not preselected.

Moreover, HPV-only primary screening for cervical cancer presents many challenges for clinicians. Questions arise regarding its effectiveness, its long-term risk, and when it is the best option for a particular patient (Austin & Zhao, 2014).

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