Toward A Better Screening for Cervical Cancer

As cervical cancer screening changes from cytology or Pap test to high-risk human papillomavirus (HPV-ar) test, primary worldwide, effective classification tests to decide who of the positive HPV-ar women should receive additional diagnostic evaluation to avoid unnecessary colposcopies and biopsies; with the evaluation of the performance of the dual staining p16 / Ki-67; and partial genotyping, HPV-16/18 for the triage of women with HPV-ar, positive; for the detection of cervical intraepithelial neoplasia grade 3 or more severe (CIN-3 +) and CIN grade 2 or more severe (CIN-2+), diagnosed within 3 years after taking the sample; better risk stratification for CIN-3+ was demonstrated, compared to Pap; in women with positive results they have a higher risk than with Pap, for CIN-3 + (12.0 vs. 10.3%; 11.6%; P = .005); even with better risk stratification for CIN-3+, compared with Pap in women with HPV-ar, positive, regardless of genotype. The greatest balance against CIN-3+ was observed in HPV-16/18 negative women or with dual negative staining, with a low risk to extend the screening intervals. Double staining triage strategies required substantially fewer colposcopies for the detection of CIC-3+ compared to Pap, with a 32.1% reduction in colposcopies compared to the triage strategy currently recommended in the detection of HPV-ar, with the Pap. The results for CIN-2+ are similar. Conclusions; the management of women with HPV-ar test, positive in the detection of cervical cancer; with support from the Pap and dual staining p16 / Ki-67, alone or in combination with HPV- 16/18 genotyping, it provides better risk stratification than strategies based only on the Pap and in countries such as Mexico, where there is organized infrastructure can detect and prevent the cervical cancer.