The role of HPV testing in global cervical cancer prevention strategies: Proceedings of a symposium supported by Cepheid (Sunnyvale, CA, USA) and held at the 31st International Papillomavirus Conference

Author List
Louise Kuhn
Heather Cubie
David Hawkes
Andrew Valley

Abstract

Every year, cervical cancer associated with human papillomavirus (HPV) infection affects nearly half a million women and causes over a quarter of a million deaths. About 83% of cases are in resource constrained countries, and it is the commonest cancer in Sub-Saharan Africa, South Asia and parts of Latin America. In part this reflects cytological screening for treatable pre-cancerous conditions, which has benefited women in more economically advanced regions. Effective cytology programmes are not feasible in low-income settings because the sensitivity of a single test is poor, necessitating regular re-screening, as well as requirements for repeat clinic visits, specialist expertise, and high-quality laboratory services. Simpler screening based on visualisation of the cervix with dilute acetic acid is recommended by the World Health Organization and has been implemented in 26 countries. However, it has had limited impact because of drawbacks which include poor specificity, rigorous training requirements, and high variability between evaluators. Recent years have seen two major technological advances in control of HPV-associated cancers – preventive vaccines and direct tests for infection with high risk HPV genotypes. While roll-out of vaccination to girls and young women is vital for future prevention, HPV testing offers the potential to transform screening for women in their middle years who are at greatest immediate risk. Cepheid sponsored this symposium at the 31st International Papillomavirus Conference to explore how HPV testing might be incorporated into cervical cancer prevention programmes in resource constrained settings. It featured expert presentations from programmes in South Africa, Malawi and Papua New Guinea, as well as under-served populations in rural Australia. Cost is a significant barrier to the introduction of HPV testing in lowe-income countries, but is not the only one. Symposium themes included modifications to test protocols to reduce costs, waste and requirements for trained staff time. In particular, self-collection of samples for HPV testing reduces the need for staff to conduct examinations, and many women may prefer it, while short turn-around is important for one-stop “screen and treat” programmes to avoid the complexity of re-calling women who test positive. Findings presented at the symposium support the need for further large-scale evaluation of HPV testing programmes to combat cervical cancer in resource constrained settings.

Every year, cervical cancer associated with human papillomavirus (HPV) infection affects nearly half a million women and causes over a quarter of a million deaths. About 83% of cases are in resource constrained countries, and it is the commonest cancer in Sub-Saharan Africa, South Asia and parts of Latin America. In part this reflects cytological screening for treatable pre-cancerous conditions, which has benefited women in more economically advanced regions. Effective cytology programmes are not feasible in low-income settings because the sensitivity of a single test is poor, necessitating regular re-screening, as well as requirements for repeat clinic visits, specialist expertise, and high-quality laboratory services. Simpler screening based on visualisation of the cervix with dilute acetic acid is recommended by the World Health Organization and has been implemented in 26 countries. However, it has had limited impact because of drawbacks which include poor specificity, rigorous training requirements, and high variability between evaluators. Recent years have seen two major technological advances in control of HPV-associated cancers – preventive vaccines and direct tests for infection with high risk HPV genotypes. While roll-out of vaccination to girls and young women is vital for future prevention, HPV testing offers the potential to transform screening for women in their middle years who are at greatest immediate risk. Cepheid sponsored this symposium at the 31st International Papillomavirus Conference to explore how HPV testing might be incorporated into cervical cancer prevention programmes in resource constrained settings. It featured expert presentations from programmes in South Africa, Malawi and Papua New Guinea, as well as under-served populations in rural Australia. Cost is a significant barrier to the introduction of HPV testing in lowe-income countries, but is not the only one. Symposium themes included modifications to test protocols to reduce costs, waste and requirements for trained staff time. In particular, self-collection of samples for HPV testing reduces the need for staff to conduct examinations, and many women may prefer it, while short turn-around is important for one-stop “screen and treat” programmes to avoid the complexity of re-calling women who test positive. Findings presented at the symposium support the need for further large-scale evaluation of HPV testing programmes to combat cervical cancer in resource constrained settings.

Article Category

Human papilloma virus (HPV)

Article Type

Supplement

Posted Date

25-10-2017

File Name
1508911644jve-3-1.pdf

The role of HPV testing in global cervical cancer prevention strategies: Proceedings of a symposium supported by Cepheid (Sunnyvale, CA, USA) and held at the 31st International Papillomavirus Conference

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