Terms used-
HRHPV- High Risk Human Pappiloma Virus
HPV- Human Papilloma Virus; LBC-Liquid Based Cytology
Cervical screening is available to women and people with a cervix aged 25 to 64 in England.
Trans men (assigned female at birth) do not receive invitations if registered as male with their GP, but are still entitled to screening if they have a cervix.
The first invitation is sent to eligible people at the age of 24.5 years.
People aged 25 to 49 receive invitations every 3 years.
People aged 50 to 64 receive invitations every 5 years.
Testing Protocol- Earlier, the cervical cancer screening program used to do cytology, and if cytology was abnormal, the sample used to be tested for HR HPV.
Now the protocol has been reversed- The sample is first tested for HR HPV.If HR HPV is positive, then cytology is done on the sample.
Rationale-
HR HPV is found in 99.7%* of cervical cancer cases .
HR-HPV testing picks up more cervical abnormalities (more sensitive) than cytology.
Most women with high-grade abnormalities will be identified by HR-HPV testing.
Women who test negative for HR-HPV have no significant cervical abnormalities (CIN2+) in 99.8%* of cases
Persistent HR-HPV infection increases the risk of women developing cervical cancer
Therefore , for screening purposes, primary HR-HPV testing coupled with cytology triage offers a more appropriate strategy( especially in an HPV-vaccinated population) .
The policy change was based on the findings of the ARTISTIC trial.
HR-HPV screening gives women longer term protection following a negative HR-HPV test result than a normal cytology result.
HOW IT’S DONE-
The cervical sample is taken as for conventional LBC
- The sample is tested for HR-HPV
- Samples that are positive for HR-HPV will then be processed for cytological examination
(cytology triage)
- Inadequate tests at any screening episode in the pathway will be repeated in 3 months
- Three inadequate tests in a row will lead to a colposcopy referral
The result of the initial sample can be as follows can be as follows-
- HR-HPV not detected – normal recall (3 or 5 years)
- HR-HPV detected, cytology negative (no abnormal cells): recall 12 months
- HR-HPV detected, cytology positive (abnormal cells found): refer for colposcopy
- Inadequate result: repeat in 3 months
If HR HPV was detected in the initial visit and cytology was negative , then the sample is repeated at 12 months.
If at 12 months-
- HR-HPV not detected: return to normal recall (3 or 5 years)
- HR-HPV detected, cytology negative (no abnormal cells): recall 12 months
- HR-HPV detected, cytology positive (abnormal cells found): refer for colposcopy.
If at 24 months, HR HPV is positive— colposcopy is done. (even if cytology is negative) . Otherwise, return to normal recall.
Special circumstances–
- HIV infection
HIV Positive women are screened annually with the HR-HPV test in accordance with programme guidelines.
- Symptomatic patient-
Women with symptoms should be referred to gynaecology or colposcopy as appropriate ( Cervical screening is not appropriate for Symptomatic women) .
Useful links-
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