HPV DNA Testing in Cervical Cancer Screening

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Abstract
Cervical cancer is the second or third leading cause of cancer in women worldwide, with about 400,000 cases diagnosed per year.1 During the past 20 years, it has been shown that the same carcinogenic, genital human papillomaviruses (HPVs) cause nearly all cases of cervical cancer,2 spurring scientists to more completely understand multistage cervical carcinogenesis, and seek HPV-related prevention strategies. The cervical carcinogenesis model underlying this study includes the 3 steps of HPV infection, progression to a high-grade preinvasive lesion, and invasion. Human papillomavirus infection is a very common sexually transmitted infection, with more than 30 genital types; however, only 10 to 15 types cause cancer.3 Current infection is measured most sensitively by DNA detection. Most infections, including those with cytologic abnormalities, resolve spontaneously, returning to HPV DNA negativity (often with seropositivity).4,5 Uncommonly, an HPV infection will progress to a high-grade preinvasive lesion (including carcinoma in situ at the most severe).6 High-grade lesions typically contain carcinogenic types of HPV. Once established, these lesions tend to persist. Many high-grade lesions become invasive cervical cancers, marked by higher frequency of genomic alteration. Invasive cancers are rare in the United States among women who are screened.7