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Test for HPV (Human Papillomavirus)

What is HPV?

Human papillomavirus (HPV) is a virus that predominates primarily by skin / mucous membrane contact. There are over 120 different types of HPV. Most HPV types provide warts, typically on hands and feet. These infections are usually overcome by themselves, and the warts disappear after a while. Some HPV types give genital warts in both men and women. These types are called "low-risk" HPV as they can not provide cancer, but "only" warts. Finally, there are 13 HPV types that can rarely give cancer. These types are called "high-risk" HPV, and are the types that focus on screening for cervical cancer. Whether it's an infection with a viral virus type, or a high-risk virus, it's important to understand that the infections go by themselves, and naturally, to oneself by far, by far, most of them. At the same time, infections with both "low-risk" HPV and high risk HPV are often quite symptom-free and for the same reason, the infected person has not been infected.

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Who is offered for screening for cervical cancer?

Screening for cervical cancer is offered to all women between 23 and 65 years, with women from 23-49 years being offered screening every 3 years, while women from 50-64 years are offered a survey every 5 years.

In Denmark, for the last 40 years, cervical cancer has been used in the form of a screening service for women between 23-65 years, and since the start of the program, efforts have reduced the number of new cancer cases a year by 2/3. The screening consists of taking a cell sample with a small soft brush (also called a smear sample) from the cervix. The test is examined in order to find cellular changes that can represent cervical cancer precursors. The difference in the length of the screening interval is due to the fact that the frequency of HPV infections is much higher in younger women than in older women.

How many women are receiving the screening offer?

About 75 percent of all women between 23-65 years participate in screening. It is very important to get more women to participate in the screening as it is the only option you have to early detect virus-dependent cellular changes that can eventually develop into cervical cancer. Although cervical cancer is a disease that can be effectively prevented, approximately 350 women receive diagnosis of cervical cancer annually in Denmark. Of these, half of the newly diagnosed cancer cases are found among the women who do not accept the screening offer. Therefore, it is important that all women participate in the screening.

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Who is offered an HPV test?

The HPV test is used routinely in three situations:

Women over 30 years cell test with unclear cell changes: HPV tests are performed in women aged 30 years or over, where the cell sample shows unclear cellular changes. In case of unclear cellular changes, the HPV test is used to assess whether cell changes should be followed by a doctor (positive HPV test), and from there the woman is referred to a gynecologist for examination. If there is no high risk HPV (negative test), the woman may return to the usual screening at 3-year or 5-year intervals depending on age. As severe cell changes or cervical cancer can not occur without concurrent HPV infection, this practice means that many women avoid unnecessary follow-up for insignificant cellular changes that are not due to an HPV infection.

Women who go for control after a cone cut: HPV test is performed in conjunction with the first cell sample in women who are checked after having had a cone cut. If the test is negative, there is no HPV present and the woman can avoid further control. If the HPV test is positive after cone nose, additional follow-up will be offered as there is still infection in the cervical tissue.

Women aged 60 or over: The third and last group of women routinely investigated with HPV testing in cervical screening are women who are 60 years or over. Here, the HPV test is used as a so-called end test.This means that the woman may stop participating in the screening program if the test is negative. If the test is positive, continued follow-up is offered. If women over 65 years of age, despite an HPV negative endpoint test, continue to be investigated for cellular changes despite an HPV negative end test, this may be done in consultation with your own doctor.

Where else on the body can you test for HPV?

HPV infections are not only limited to the cervix, but can also be found in the outer genital organs, rectum and oral cavity of men and women. In these cases, HPV can rarely be a contributing factor to cancer development. HPV tests can also be taken from these areas and analyzed for the presence of HPV. HPV tests in this regard are used solely on those patients who have been diagnosed with cancer to determine if the cancer has occurred due to HPV virus or may be another cause. You can not ask your doctor for the test for preventive purposes.

HPV can be detected either in a cell sample with a swab or small brush scrape cells from the cervical surface, from the penis, from the rectum, from the oral cavity or the throat. One can see cases where wort-like changes in the skin suspect HPV, and then take a small tissue test for HPV test; However, this is only done if there are visible changes in the skin or in the mucous membranes.

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How to test for HPV?

HPV is a so-called DNA virus, and therefore DNA technology is used for the analysis. Exactly which analysis is used, select the laboratory to perform the analysis. In Denmark, there are guidelines that set a number of requirements for the HPV test used. This means that we at national level have a very high quality in the tests used.

Most Danish pathology departments can both test for low-risk and high-risk HPV and also investigate which HPV subtype is responsible for that infection. However, it is most likely to investigate whether HPV is high or low risk with regard to the further control or treatment course. Typing is used so far only in special cases.

Advantages and Disadvantages of HPV Test and Cell Samples

The screening program is designed so that you can find women with treatment-intensive cell changes with great certainty. Since no survey is 100 percent safe, some women will find that, although they have closely followed the screening program, there are still signs of cancer in their cell test. Some cases of cervical cancer are also found among women who have not received the screening offer. It is therefore of the utmost importance to participate in the screening as this is the prerequisite for cellular changes to be detected on time.

A combination of a cell sample and an HPV test is better in certain situations to find women who have treatment-demanding cellular changes. HPV tests alone trigger relatively many "false alarms", in particular women in the younger age groups have an HPV infection, but where the infection does not have an immediate meaning and typically will resume naturally. Therefore, the combination, as we know from Denmark, between cell-based studies and HPV tests, is very effective and balanced to find the women who 1) should be followed up, or 2) who should return in 3 or 5 years.

Future screening for cervical cancer

With 450,000 participating women a year, the screening program for cervical cancer is one of the biggest preventive interventions in the Danish health service. Work is constantly being done to improve efforts. In 2014-2015, HPV home testing in the Capital Region is being investigated where women who have not participated in screening for an extended period of time are offered to take a test for HPV testing at home and submit it for analysis. At the same time, several Danish screening departments are active in international research groups working on designing an optimal screening program where HPV testing replaces the current cell-based test.

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