Methodologies of Primary HPV Testing Currently Applied for Cervical Cancer Screening

Abstract

The human papillomavirus is one of the most common sexually transmitted viruses, and an infection from this virus may become persistent, leading to diseases such as cervical cancer. In the past, cytology-based methods such as the Papanicolaou (Pap) test were imperative to identify the disease at a stage where it can be treated. However, since the 1980s where the etiological association of HPV and cervical cancer was identified, new tests began emerging directed towards identifying the virus. Furthermore, as the biology of HPV along with the relationships with its host are elucidated, these tests and treatments further advance. Recently in Europe, there is a movement towards the implementation of HPV testing methodologies in national screening programs to precede cytological testing. These screening strategies are recommended by the European guidelines and the World Health Organization. This review presents the current HPV testing methodologies, their application in organized population-based cervical cancer screening programs based on the most recent European guidelines, and their implementation status in countries in Europe.

Keywords: HPV testing; cervical cancer; human papillomavirus.

Figure 1

Management algorithm in primary HPV screening. Abnormal cytology refers to a borderline or more severe cytological result. This figure was adapted from Chrysostomou et al. (2018) [15]. This algorithm was developed based on “The supplements of the second edition of the European Guidelines for Quality Assurance in Cervical Cancer Screening of 2015” [27].

Figure 2

The implementation status of primary HPV testing in E.U. member states and some E.U. associated countries. This figure was adapted from Chrysostomou et al. (2018) [15], and it is updated with new information. The magnifying glass serves to enlarge the island of Malta. It is important to state that this is a rapidly changing field and that the status of implementation could not be confirmed for all countries from two independent sources.