HPV testing refers to testing for oncogenic human papillomavirus (HPVHuman papillomavirus) types. Oncogenic HPV typesOncogenic HPV are HPV types considered capable of causing cancer. Types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 are included in tests suitable for cervical screening. Some tests also detect type 66. are defined as those associated with the development of invasive cervical cancer, and include HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68. HPV testing can be performed using a range of technologies including DNA PCRPolymerase Chain Reaction, DNA hybridisation, and testing for RNA.
Technologies that are to be used in the National Cervical Screening Program (NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears.) will be required to meet performance standards as determined by the National Pathology Accreditation Advisory Council (NPAAC).
The role of partial genotyping
The risk of having, or developing, cervical intraepithelial neoplasia (CINCervical Intraepithelial NeoplasiaRefers to abnormal changes in the cells on the surface of the cervix that are seen using a microscope (i.e. histologically-confirmed).CIN 1 – Mild dysplasiaCIN 2 – Moderate dysplasiaCIN 3 – Severe dysplasia to carcinoma in situ(The term CIN 2+ refers to CIN 2, 3, or invasive cervical cancer; CIN3+ refers to CIN 3 or invasive cervical cancer)CIN 2/3 refers to CIN 2 or CIN 3.) grade 3 or higher (CIN3+) can be stratified based on the results of partial genotyping on an HPV test. Several epidemiological analyses have been performed to inform estimates of the longitudinal risk associated with each HPV type. For example, Khan and colleagues calculated the cumulative incidence rates (CIRThe cumulative incidence rate is a cumulative hazard for a specific disease and should be distinguished from crude (or absolute) risk.) of CIN3+, including cancer, over a 10-year period as follows:
- 17.2% for women with a positive oncogenic HPV test result (type 16)
- 13.6% for women with a positive oncogenic HPV test result (type 18)
- 3% for women with a positive oncogenic HPV test result (not 16/18)
- 0.8% for women in whom oncogenic HPV is not detected.
HPV testing within the NCSPNational Cervical Screening ProgramA joint program of the Australian, state and territory governments. It aims to reduce morbidity and mortality from cervical cancer, in a cost-effective manner through an organised approach to cervical screening. The program encourages women in the target population to have regular Pap smears. includes partial genotyping for HPV types16 and 18, as these types are managed differently to other oncogenic HPV types (not 16/18) in the program (see Oncogenic HPV types 16/18 in Chapter 6. Management of oncogenic test results).
Some HPV test platforms provide additional channels for reporting HPV 31, 45 and/or other (not 16/18) oncogenic types, as part of their partial genotyping reporting. Some test platforms report HPV 18 and 45 together. For assays that do not distinguish between oncogenic HPV 18 and 45, a woman in whom type 18/45 is detected should be managed as for women with a positive oncogenic HPV (16/18)Women with a positive HPV test result of HPV types 16 and/or 18 detected using routine HPV testing in a pathology laboratory. test result.
For the purpose of reporting, this guideline recognises the following categories for HPV test results (see Preparation of cervical screening reports):
- HPV 16/18Only HPV types 16 and or 18 detected using routine HPV screening tests in laboratory. detected
- oncogenic HPV (not 16/18) detected
- oncogenic HPV not detectedOncogenic HPV types not detected by the HPV testing platform..
- Muñoz N, Bosch FX, de Sanjosé S, Herrero R, Castellsagué X, Shah KV, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 2003 Feb 6;348(6):518-27 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12571259.
- Khan MJ, Castle PE, Lorincz AT, Wacholder S, Sherman M, Scott DR, et al. The elevated 10-year risk of cervical precancer and cancer in women with human papillomavirus (HPV) type 16 or 18 and the possible utility of type-specific HPV testing in clinical practice. J Natl Cancer Inst 2005 Jul 20;97(14):1072-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16030305.