High Risk Human Papillomavirus (HR HPV) testing, molecular biomarkers and HPV vaccination, and their potential impact on the cervical cancer screening paradigm in Australia

Costanzo Fusco

Research output: ThesisDoctoral Thesis

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Abstract

Introduction
The Australian cervical screening program will change to a new paradigm in December 2017. The National Cervical Renewal Program, the Cervical Screening Test (CST) will change the primary screening from a cytology based conventional Papanicolaou (pap) smear to a high risk Human papillomavirus (HPV) molecular screen for cervical cancer. This change takes into account the impact that HPV vaccination has on the community, along with a better understanding of the natural biology of HPV as being the main causative agent of cervical cancer. This report looks at the implications the paradigm change will have on the discipline of cytology, cytologists, industry practise and patients.

Method
The report will look at high risk HPV (HR HPV) testing, the impact on the previous paradigm, the new CST and its limitations. This will be based on industry experience, literature review and an investigation on the follow-up of low grade squamous lesions (LSIL). This report also looks at the use of biomarkers (p16/Ki67) as an indicator of high grade lesion presence, its potential benefits in cervical cancer screening and its absence from the new CST.

Results
The report finds that HR HPV has had a significant impact on cervical screening in Australia, this has had a major impact on the role of cytologists and the number of cytologists required in the workforce. Limitations of the CST have been identified and the following areas may require consideration for adoption in future refinements to this program.

1.HPV positive (16/18 only) are sent to colposcopy 16/18 negatives are not.
2.HPV positive (16/18 negative) liquid based cytology (LBC) LSIL are not sent to colposcopy.
3.Biomarkers (p16/Ki67) are not used to triage high grade lesions.

Conclusion
The CST has changed the way cervical screening is practised in Australia. The move to a molecular based primary screening test has impacts on protocols, cytologists and patients. Investigation into LSIL follow-up detected a 20% progression to high grade lesions on histology 24 months post LBC triage diagnosis and highlighted the importance of biomarkers (p16/Ki67) in the identification of high grade lesions. This investigation demonstrated limitations within the new CST. These may impact future policy, protocol, knowledge and paradigm change.

Key words: Human Papillomavirus (HPV), cytology, cervical screening test (CST), biomarkers
Original languageEnglish
QualificationDoctor of Health Science
Awarding Institution
  • Charles Sturt University
Supervisors/Advisors
  • Kalle, Wouter, Principal Supervisor
  • Bwititi, Phillip, Co-Supervisor
Publisher
Publication statusPublished - 2019

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