HPV Immunisation, Triage and "Test of Cure"

List of contents.

1.   abbreviations

2.   HPV immunisation programme

3.   HPV triage

4.   HPV "Test of Cure"

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Abbreviations.

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HPV immunisation programme.

This started in 2008 with 12 & 13-year-old girls.

The bivalent vaccine Cervarix was used.

There was a "catch-up" programme for girls aged 14 - 17 years.

It was intended that this would be completed by 2011.

The quadrivalent vaccine Gardasil will be used from September 2012.

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HPV Triage.

The 2011 annual review of the NHSCSP set out a policy for the introduction of HPV testing alongside routine cytological testing of cervical smears.

There had been testing done in test sites for about a decade.

The conclusion was that HPV testing would be advantageous and even cost-saving in the medium term.

HPV triage will be introduced in 2011 and 2012 for low-grade abnormalities.

HPV testing will routinely be done when a smear shows borderline changes or mild dyskaryosis.

If the HPV test is +ve, colposcopy will be recommended.

If the HPV test is –ve, the woman will be referred back for routine recall.

Women whose smears show more severe abnormalities will go for colposcopy, as before.

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Test of cure

“Test of cure” will come in during 2012 and 2013.

You can’t tell anyone that they have been cured after treatment for CIN.

But you can say that they are at very low risk of disease progression.

Women who have had treatment for CIN will have a smear at 6 months.

Under the present policy, most will go on to have annual smears for 10 years.

“Test of cure” completely changes that.

If the smear at 6/12 puts them at low risk, i.e. it is normal or only showing borderline changes or mild dyskaryosis, then HPV testing will be done.

If this is negative, they will be in a very low risk category and can have their next smear as per routine recall.

If the HPV test is +ve or more serious atypia are reported, colposcopy is recommended.

It is reckoned that there will be an initial rise in the number of colposcopies and then a significant fall.

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Suggested reading.

BSCCP's summary of HPV testing and test of cure.

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NHSCSP's Colposcopy and programme management May 2010.

NHS cancer screening programme summary.

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