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HPV and Cervical Cancer Screening Medical Guidelines

HPV Medical Guidelines

HPV testing along with a Pap is emerging as the standard of care and is acknowledged in clinical guidelines developed by major medical groups including the American College of Obstetricians and Gynecologists (ACOG), the American Cancer Society (ACS), the Association of Reproductive Health Professionals (ARHP) and the American Society for Colposcopy and Cervical Pathology (ASCCP).

Evolution of Cervical Cancer Screening and HPV Testing Medical Guidelines
2005	An April 2005 ACOG Practice Bulletin on HPV described HPV testing as "more sensitive than cervical cytology" for detection of CIN 2/3 and cervical cancer. ACOG reported that combining HPV testing with cytology has "a negative predictive value for CIN 2 and CIN 3 of 99 to 100 percent," and stated that "because HPV DNA testing is more sensitive than cervical cytology…women with negative concurrent test results can be reassured that their risk of unidentified CIN 2 and CIN 3 or cervical cancer is approximately 1 in 1,000." Addressing the impact of test results on patient management, ACOG recognized the interim patient management guidelines published in 2004 (see below) and recommended that women age 30 and older who have high–risk HPV but negative cytology have both tests repeated in 6–12 months. Women with persistent HPV on repeat testing "should undergo colposcopy regardless of the cytology result." Click here for additional information on the 2005 ACOG Practice Bulletin.
2004	In 2004, the NIH, ASCCP and ACS supported a workshop that resulted in the publication of "Interim Guidance for the Use of HPV DNA Testing as an Adjunct to Cervical Cytology for Screening" in Obstetrics and Gynecology. The guidance particularly focused on how to manage women with normal Pap results but who have high–risk HPV. Click here for additional information on the interim guidance.
2003	Following FDA approval of The Digene^® HPV Test* for primary screening together with a Pap (March 2003), ACOG issued a Practice Bulletin for cervical cytology screening. It recommended the combined use of a Pap and HPV test for women age 30 and older, although it stated that the supporting scientific evidence was "limited and inconsistent" at that time. Click here for additional information on the 2003 ACOG Practice Bulletin. In September 2003, ARHP published a document called Clinical Proceedings: Advances in Cervical Cancer Prevention, which incorporated the ACOG recommendations for primary screening, including the use of the Pap along with high–risk HPV testing in women age 30 and older. Click here for additional information on the ARHP Clinical Proceedings.
2002	In November 2002, the ACS published guidelines recommending that healthcare professionals consider ordering a high–risk HPV test along with a Pap as a primary cervical cancer screen. Click here for additional information on the ACS guidelines.
2001	In 2001, the ASCCP sponsored the first evidence–based, national practice guidelines on managing patients with abnormal Pap results. When liquid–based cytology is used or when co–collection for HPV DNA testing is done, reflex HPV DNA testing is cited as the "preferred approach" for resolving ASC–US Pap results. Click here for additional information on the ASCCP guidelines.

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* "The Digene HPV Test" was approved by the US FDA and is also known to laboratories and physicians as the "hc2 High–Risk HPV DNA Test^®" and "DNAwithPap^® Test." This does not refer to the Digene product that tests for several types of the virus commonly referred to as "low–risk HPV," which are not associated with cervical cancer.