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The case for co-testing in cervical cancer screening

For more confident identification of precancer as early as the very first test

Pap Smear

A new approach to cervical screening is being rolled out across the UK, lead by healthcare providers determined to further reduce the incidence of cervical cancer: triage of borderline and low-grade dyskaryosis cytology with HPV testing (pooled) for women 25-64 years of age has been introduced in England and Northern Ireland. England, Northern Ireland, Scotland and the Republic of Ireland have introduced HPV testing as test of cure/post treatment testing.

Cytology alone has a low degree of sensitivity within a single screening round1,2. While sensitivity increases over several screening rounds, during this time, undetected disease may be progressing. In an overview of over 60,000 women, a single round of HPV testing has been shown to have a sensitivity of about 90% for cervical cancer and its precursor lesions2, establishing cervical cytology together with HPV testing as superior over cytology alone in detecting precancer and cancer of the cervix.                                                                              

1 in 10 women who are positive for HPV 16 and/or 18 have high-grade cervical disease that is missed by cytology.3

A cervical screening algorithm using the widespread confidence in liquid based cytology (LBC) combined with hrHPV triage gives clinicians a greater opportunity to address precancer risk, and gives women greater certainty and less ambiguity around understanding their own risk of cervical cancer. Here is what hrHPV triage and test of cure/post treatment testing could mean for your practice:

  • Enhanced risk-stratification that allows you to focus on those women in need of the greatest care, and reassure the vast majority that they are at very low risk and protect them from unnecessary interventions.
  • Early identification of high-grade disease potentially undetected by cytology alone.
  • Early return of women to routine recall.

Data supports the benefits of HPV testing.

A growing body of literature supports the benefits of pooled hrHPV DNA testing. The large Sentinel Sites Study, performed in England on behalf of the NHSCSP, showed that HPV testing as triage and test of cure/post treatment testing promoted:4,5

  • Identification of women with borderline cytology or low-grade dyskaryosis who test negative for hrHPV and are at low risk of developing cervical cancer, and their early return to routine recall at 3 or 5 years, depending on their age. 
  • More effective triage of women with low grade abnormalities that do require colposcopy assessment.
  • Identification of women who are negative for hrHPV following treatment and can safely be returned directly to routine recall without the need of the long management normally associated with follow up after treatment.

A large U.S. observational study in addition showed that HPV testing aided: 6

  • Identification of women who developed cervical cancer, notably adenocarcinoma, an uncommon but particularly lethal form of cervical cancer whose precursors are poorly identified by cytology alone.
  • Safe screening interval extension for women with normal cytology who are also HPV negative.

Hear from the experts:

Find out how triage with hrHPV testing can help patients.

The videos are intended to provide educational information and the opinions of the speakers may not be supported by Roche in their entirety. While we do our best to fact check all information presented, you should not rely on this information as complete, or always up-to date. In particular, nothing in the videos is intended to constitute medical advice and the videos should not be relied on for this or any other purpose.

  • Acronyms:


1. The ASCUS-LSIL Triage Study Group. Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance. Am J Obstet Gynecol. 2003;188(6):1383-1392.

2. Cuzick J, Clavel C, Petry K, et al. Overview of the European and North American studies on HPV testing in primary cervical cancer screening. Int J Cancer. 2006;119(5):1095-1101.

3. Wright TC Jr, Stoler MH, Sharma A, et al. Evaluation of HPV-16 and HPV-18 genotyping for the triage of women with high-risk HPV+ cytology-negative results. Am J Clin Pathol. 2011;136(4):578-586.

4. Kelly RS, Patnick J, Kitchener HC and Moss SM on behalf of the NHSCSP HPV Special Interest Group. HPV testing as a triage for borderline or mild dyskaryosis on cervical cytology: results from the Sentinel Sites study. Br J Cancer. 2011;105: 983–988. doi:10.1038/bjc.2011.326.

5. Moss S, Kelly R Legood R, Sadique Z, Canfell K, Lew JB, Smith M, Walker R. EVALUATION OF SENTINEL SITES FOR HPV TRIAGE AND TEST OF CURE -Report to the NHS Cancer Screening Programmes. September 2011.

6. Katki HA, Kinney WK, Fetterman B, et al. Cervical cancer risk for women undergoing concurrent human papillomavirus and cervical cytology: a population-based study in routine clinical practice. Lancet Oncol. 2011;12(7):663-672.