Page 20 - Screening for Cervical Cancer: Systematic Evidence Review

Chapter I. Introduction

estimating the viral burden; and some methods allow assessment of degree of integration of HPV

into the host genome. Tests differ in the method for processing the DNA analyzed, the quantity

of specimen required, and difficulty of analysis.

Because the family of HPV viruses is large, and because only a small group of those

types is associated with cervical dysplasia and cervical cancer, tests that identify specific viral

types or panels of high-risk viral types are preferable to detection of all HPV types. A multitude

of laboratory methods has been applied to studying HPV. However, these approaches are not all

equally applicable to screening. Considering the reliability and relative performance

characteristics of the assays in controlled settings in the laboratory and their potential for

application to screening, we have adopted the classification of HPV testing technologies

presented in Table 1.

This is a modification of the classification used by John Cuzick, his co-authors, and an

expert panel of the Health Technology Assessment Board of the UK National Health Service in

their Systematic Review of the Role of Human Papillomavirus Testing Within a Cervical Cancer

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Screening Program. Based on consultation within our team, with our USPSTF liaisons, and

with other experts, we have focused our review on evaluation of clinically collected cervical

samples using Hybrid Capture II (HCII) and on type-specific, the SHARP detection system, or

conventional consensus PCR.

Health Care Interventions

Reduction of morbidity and mortality associated with squamous cell carcinoma of the

cervix is the ultimate goal of screening. The screening system used must be acceptable to

patients and providers and detect abnormalities that are amenable to intervention. The broad

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