Implementing point-of-care cervical cancer screening programmes: moving towards scale-up

Abstract

Proceedings of a symposium supported by Cepheid (Sunnyvale, CA, USA) and held at the 32nd International Papillomavirus Conference, 2–6 October 2018, Sydney, Australia.

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 more economically advanced regions, cervical cancer incidence and mortality are lower in part because women have benefited from cytological screening for treatable pre-cancerous conditions. However, 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 laboratory infrastructure. Simpler screening based on visualisation of the cervix with dilute acetic acid with same-day treatment has been implemented in several lower-income countries, but has had limited impact because of drawbacks including poor specificity, rigorous training requirements, and high variability between evaluators.

Recent years have seen two major technological advances in the control of HPV-associated cancers – preventive vaccines and direct tests for infection with high-risk HPV genotypes. While vaccination can protect girls and young women from future infection, HPV testing offers the potential to transform screening for women in their middle years who are at greatest immediate risk. Following a previous event on the role of HPV testing in cervical cancer prevention, these proceedings report on a Cepheid-sponsored symposium at the 32nd International Papillomavirus Conference in Sydney, Australia in October 2018, and focus on the benefits and challenges of scaled-up screening with the Xpert® HPV assay, including its use in same-day ‘test and treat’ strategies in lower-income and remote settings.

Proceedings of a symposium supported by Cepheid (Sunnyvale, CA, USA) and held at the 32nd International Papillomavirus Conference, 2–6 October 2018, Sydney, Australia.

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 more economically advanced regions, cervical cancer incidence and mortality are lower in part because women have benefited from cytological screening for treatable pre-cancerous conditions. However, 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 laboratory infrastructure. Simpler screening based on visualisation of the cervix with dilute acetic acid with same-day treatment has been implemented in several lower-income countries, but has had limited impact because of drawbacks including poor specificity, rigorous training requirements, and high variability between evaluators.

Recent years have seen two major technological advances in the control of HPV-associated cancers – preventive vaccines and direct tests for infection with high-risk HPV genotypes. While vaccination can protect girls and young women from future infection, HPV testing offers the potential to transform screening for women in their middle years who are at greatest immediate risk. Following a previous event on the role of HPV testing in cervical cancer prevention, these proceedings report on a Cepheid-sponsored symposium at the 32nd International Papillomavirus Conference in Sydney, Australia in October 2018, and focus on the benefits and challenges of scaled-up screening with the Xpert® HPV assay, including its use in same-day ‘test and treat’ strategies in lower-income and remote settings.

Article Category

Human papilloma virus (HPV)

Article Type

Supplement

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