Cytopathology in focus: Exchange of views—HPV screening policies in Australia

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Working group members from Australia wrote a rebuttal in the form of a letter to the editor criticizing the assumptions Cox and Sneyd made in their analysis. They emphasize that HPV screening can detect precursors earlier than cytology and that treatment will prevent the progression to invasive cancer.

In their editorial, Austin and Herbert discuss the challenges of understanding meta-analysis and biases that screening model predictions may introduce. They discuss concerns related to HPV-negative cancers that will not be detected by primary HPV screening. High-grade CIN is the preferred target for treatment and prevention of invasive cervical cancer and has been commonly used as a surrogate for cancer in most screening trials worldwide. However, the effectiveness of any cancer screening program is best documented through long-term observational studies, which find a decrease in both invasive cancer incidence and mortality in a screened population. Cervical cytology, which is historically the most successful cancer screening test, provides the only data thus far to demonstrate a decrease in cervical cancer mortality. Countries that have already switched to HPV screening will accrue data with time.

1. Cox B, Sneyd MJ. HPV screening, invasive cervical cancer and screening policy in Australia. J Am Soc Cytopathol. 2018;7(6):292–299.
2. Smith MA, Brotherton JML, Hammond IG, et al. Inaccurate and fundamentally flawed analysis risks undermining confidence in cervical screening programs [Letters to the Editor]. J Am Soc Cytopathol. 2018;7(6):336–338.
3. Cox B, Sneyd MJ. Response to Smith et al. [Letters to the Editor]. J Am Soc Cytopathol. 2018;7(6):338.
4. Austin MR, Herbert A. Whose cervical cancer screening model predictions will prove to be correct? J Am Soc Cytopathol. 2018;7(6):289–291.

Dr. Davey is associate dean for graduate medical education, University of Central Florida, and practices pathology at the Orlando VAMC. She is a member of the CAP Cytopathology Committee.