New technologies for cervical cancer screening

Key Points

• New methods for cervical screening are expected to improve diagnosis while reducing the demand on cytology and colposcopy services
• A model is proposed in which HPV testing is used as the first screening method, with cytology only for those who are positive for the virus
• Self-sampling is a feasible option with HPV testing, and may help to increase uptake of screening

 

Introduction

The rate of deaths caused by cervical cancer continues to fall—2.3 per 100,000 in England in 2008, compared with 3.2 per 100,000 in 1999¹—a change largely attributable to the work of the NHS Cervical Screening Programme. At present, screening is dominated by cervical cytology, a process that relies on women accepting regular invitations to undergo smear tests, accurate cell sampling conducted by a trained professional, and the work of skilled cyto-screeners. Women found to have pre-cancerous changes—cervical intraepithelial neoplasia (CIN, Table 1)²—are referred for colposcopy. Of the 134,000 referrals to colposcopy in England in 2008–09,¹ 31% were for CIN grade 1, and 18% for borderline changes.³ New methods for detecting women at risk of cervical cancer are becoming available and, if introduced, may help to reduce the number who need to attend for cervical cytology and colposcopy—with the possibility of financial and organisational benefits for local healthcare services. Some of these methods—and perhaps the most likely to be seen in routine practice in the near future—test for human papillomavirus (HPV), the organism that causes cervical cancer.⁴

This article considers the potential role of HPV testing in cervical screening, and looks ahead at an immunostaining test that may also hold promise in this clinical arena.

CIN grade	Degree of cell abnormality (dyskaryosis)	Thickness of cervical lining in abnormal cells
CIN 1	Mild	One third
CIN 2	Moderate	Two thirds
CIN 3	Severe	Full thickness*

*CIN remains only pre-cancerous, even at CIN 3

Table 1: CIN terminology in cervical cancer screening²

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