Abstract IA12: Risk-assessment in HPV-based cervical cancer screening

Abstract

Cervical cancer screening is rapidly evolving to incorporate highly accurate molecular methods that are able to categorize women9s risk of cervical cancer and allow recommendations for follow-up or treatment. HPV nucleic acid testing provides highly sensitive and reproducible detection of HPV infection, a necessary cause of cervical cancer. Thus, virtually all women who have a cervical cancer precursor or who will develop one in the following years are HPV positive. On the other hand, the vast majority of HPV positive women have transient infections that will disappear in a few months. In this context, further evaluation of HPV positive women using triage methods allows further risk stratification that avoids unnecessary evaluations and overtreatment. Women positive for the triage test are referred for immediate colposcopic evaluation and follow-up (or, in some contexts, immediate treatment) as needed, while those who test negative usually receive another screening test in a year (or more). Triage with cytology or co-testing with HPV and cytology selects a group at clearly higher risk and generally above the recommended threshold for immediate colposcopy referral based on current consensus guidelines. For HPV positive women, genotyping for HPV 16 and 18 allows further risk stratification, but the additional benefit of other HPV genotypes is unclear. Ideally, triage methods are performed on the same specimen where the HPV test was carried out, to avoid additional visits. Risk stratification is different in different populations and age groups as HPV prevalence and type distribution, as well as screening histories are highly variable around the world. The programmatic decisions need to take into account the feasibility and logistics of different approaches and their respective burden on health services. Further research, particularly in low and middle income countries and in vaccinated cohorts is required. Citation Format: Rolando Herrero. Risk-assessment in HPV-based cervical cancer screening. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr IA12.