• Camelia Brande

HPV screening methods

New month, new topic! We are dedicating February to a very important topic, which sometimes does not get enough attention even though it is so common. Wondering what we are talking about? Well, no other than one of the most common sexually transmitted infections, HPV.

In the last weeks we discovered what HPV is, what diseases it can cause and how we can prevent from getting an infection.

But undergoing regular checkups is important as well. Curious what the currently available screening methods are?

Let’s find out!


HPV stands for Human papillomavirus and it is one of the most common dermatologic and sexually transmitted infections. Almost every sexually active person will get infected with HPV at one point during their life.


Currently, over 200 types of HPV have been discovered. Only a few are considered high risk and potentially cancerous. HPV can be classified based on its risk of developing various conditions such as genital warts or cancer:

  • High risk: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, 82

  • Probable high risk: 26, 53, 66

  • Low-risk: 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81


Since 1941, when Dr. Papanicolau published his work on the pap smear, this screening method for cervical cancer has had a significant impact on lowering the prevalence of morbidity and mortality from HPV cancer related diseases. Along with the development of an HPV test in 1998, cervical cancer has become a disease that can be detected in time and even prevented.

In the US, the rates of cervical cancer declined from 36.3 per 100 000 women in 1930s to 7.32 per 100 000 women in the 1990s. This significant decrease correlates with the implementation of cervical cancer screening methods.


Currently available screening methods for cervical cancer


Pap smear test (Papanicolau test)

  • It is known as cytology testing, as it identifies cervical lesions

  • The test takes place during a gynecological consultation, where a healthcare professional takes a sample of cells from the cervix and sends it to a lab for analysis

  • The optimal screening protocol for cervical cancer identifies cervical lesions when treatment can cure the disease, while limiting the overtreatment

  • The sensitivity of pap smear for detecting precancerous or cancerous lesions is up to 53%, meaning that almost half of women tested can receive a false positive or a false negative diagnostic

  • This false positive results can lead to treatments that are not needed

  • The pap smear collection should not be done during menstruation, shower, sexual intercourse

  • Use of tampons, local contraception or other vaginal products should be avoided 48 hours before undergoing a pap smear test


HPV (Human papillomavirus) testing

  • Detects the infections with the human papillomavirus that, if left untreated, could lead to genital warts or HPV related cancers

  • The test takes place during a gynecological consultation, where a healthcare professional takes a sample of cells from the cervix and sends it to a lab for analysis

  • Currently, more than 100 different HPV testing methods are available in the US and Europe

  • In 2014, the FDA approved the use of HPV tests alone for a primary cervical cancer screening

  • The HPV screening tests for the presence of the virus, whereas the pap smear detects abnormal changes of the cervical tissue. Since it is proven that the human papillomavirus is responsible for 95% of cervical cancers, many countries start using the HPV test as a primary screening method

  • In the decades to come, studies suggest that HPV testing will become the standard method for cervical cancer screening in both developing and developed countries


Visual inspection with acetic acid (VIA)

  • The test takes place during a gynecological consultation, where a healthcare professional applies acetic acid (diluted vinegar) to the cervix in order to observe abnormal modifications of the cervical cells

  • It is used for detecting precancerous cervical lesions

  • It is less available than the pap smear and the HPV test


Cervical screening guidelines (2015)

  • Initial screening at the age of 21 years

  • Pap smear test every 3 years from 21 until 29 years

  • Initial HPV testing at the age of 25 years

  • Co-testing (HPV test and pap smear test) every 5 years beginning with the age of 30

  • For women with abnormal results during a pap smear test or with an HPV test positive, it is recommended to repeat the pap smear test every 12 months between 21 and 25 years. If test results are the same after one year, women can be offered to undergo a colposcopy (visual examination of the cervix using an instrument called colposcope)

  • Screening ends at 65 for women that have a low risk of developing HPV-cancer related diseases

  • Women that have been vaccinated against HPV should still undergo screening


According to the National Health and Nutrition Examination Survey, conducted in the US between 2003 and 2006, the HPV prevalence in the US for people under 20 years is estimated to be around 33% while for those between 20 and 24 years it rises up to 43%. This study suggests that even though the prevalence of HPV in women over 20 is pretty low, it is still recommended to do a screening method as HPV related cancers develop over decades. This screening can detect early abnormal modifications.


For diagnosing invasive cervical cancer (cervical cancer that has spread deeper tissue of the cervix or other parts of the body) the following methods are available

  • Colposcopy (visual examination of the cervix using an instrument called colposcope)

  • Fluorescence spectroscopy (optical detection method that can diagnose and monitor abnormal changes in tissue cells) and polar probe (portable non invasive electronic device designed for the detection of cervical precancer and cancer)

  • HPV DNA test

  • New methods of cervical smear preparation

  • Methods of automated cervical smear examination

  • Pelvic MRI and PET-CT

Even though studies and reality have proven the significant impact the screening methods have on lowering the prevalence of HPV, there are still barriers limiting the use of screening methods.

Studies that researched the knowledge of cervical cancer and pap smear, and what influences women when it comes to this showed:

  • The main reasons women do not undergo cervical screenings are: lack of knowledge (44.3%), embarrassment (18.2%), fear of result (13.1), painful test (10.8%), not being recommended by health workers (8.5%) and lack of trust to health workers

  • Ways to increase the number of cervical screening methods performed worldwide can happen through: recommendations by health workers, family and friends, learning the signs of disease and the methods of screening, managing to perceive the real risk of cancer, providing easy and affordable access to pap smear tests


Lack of knowledge and little awareness seem to be the prevalent barriers in preventing HPV infections. Therefore, it remains one of the most common sexually transmitted infections that can easily develop into deadly diseases. An important influence on decreasing the prevalence of HPV is increasing and spreading awareness about this STI, starting with us!


Be smart. Be (c)LIT. Fly with us!🌺🐝


Sources:

https://pubmed.ncbi.nlm.nih.gov/26519782/

https://pubmed.ncbi.nlm.nih.gov/30146348/

https://pubmed.ncbi.nlm.nih.gov/27273940/

https://pubmed.ncbi.nlm.nih.gov/28409172/

https://pubmed.ncbi.nlm.nih.gov/26808257/

https://www.paho.org/hq/index.php?option=com_docman&view=download&category_slug=fact-sheets-3574&alias=36302-fact-sheet-4-early-detection-tests-to-prevent-cervical-cancer-302&Itemid=270&lang=en

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