%0 Journal Article
%T The Clinical Role of HPV Testing in Primary and Secondary Cervical Cancer Screening
%A G. Hoste
%A K. Vossaert
%A W. A. J. Poppe
%J Obstetrics and Gynecology International
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/610373
%X Traditional population-based cervical screening programs, based on cytology, have successfully reduced the burden of cervical cancer. Nevertheless limitations remain and new screening methods are emerging. Despite vaccination against the 2 most oncogenic types (HPV 16/18), cervical cancer screening will have to continue as an essential public health strategy. As the acquisition of an HR-HPV infection is critical in the progression to (pre-)cancerous cervical lesions, recent research has focused on HR-HPV detection. The sensitivity of HPV testing in primary and secondary prevention outweighs that of cytology, at the cost of slightly lower specificity. Although most of the HR-HPV infections are cleared after conization, new evidence from numerous studies encourages the implementation of HR-HPV testing and genotyping to improve posttreatment surveillance. An HR-HPV test 6 months after conization is a promising useful clinical marker to detect persistence and prevent progression. This review highlights the clinical role of HPV testing in primary and secondary cervical cancer screening. 1. Burden of Cervical Cancer Cervical cancer (CC) is the third most common cancer among women worldwide (15%) and the second most common in developing countries [1]. It is estimated by the World Health Organization that every year approximately 530000 women are diagnosed with CC worldwide and 275000 women die from the disease [2]. More than 80% of the global burden occurs in developing countries, where it accounts for 13% of all female cancers. In western countries, the incidence and mortality of CC have declined substantially over the past decades, whereas in developing countries there is a slight increase in mortality (Figure 1). This is probably due to the lack of screening and the greater impact of infectious cofactors in the latter regions [3]. Age-adjusted incidence rates vary from about 10 per 100000 per year in many industrialized countries to more than 40100000 in some developing countries. More than 88% of deaths occur in low-income countries and it is predicted to increase to 91.5% by 2030 [4]. Figure 1: Estimated cervical cancer incidence worldwide in 2008. GLOBOCAN 2008, International Agency for Research on Cancer. The red and dark highlighted areas have the highest incidence rates. Infection with a high-risk HPV (HR-HPV) genotype has been identified as the most important etiologic risk factor for the development of CC and is the necessary step in carcinogenesis. The median age of diagnosis is 45 years, and there are two major histological types; 85% of all cases
%U http://www.hindawi.com/journals/ogi/2013/610373/