The use of human papillomavirus typing in detection of cervical neoplasia in Recife (Brazil)

High risk types of human papillomavirus (HR-HPV) play a major role in cervi cal cancer oncogenesis. This study aims to evaluate the efficacy of HPV det ection and typing as a means of identifying cervical neoplasia in a high ri sk population. A management algorithm for implementation of HPV detection i n clinical practice is also proposed. A nested case-control within a cohort study was undertaken in Recife (Brazil). All 479 participants had cervical scrapes collected for HPV detection followed by colposcopy. Samples were b lindly analyzed by polymerase chain reaction (PCR) and typed by restriction fragment length polymorphism (RFLP). HPV detection by PCR and typing with RFLP cost US$ 4.92 per woman screened in this study and is significantly better than cytology in identifying wome n at risk of developing cervical cancer (P = 0.0001). Women who tested posi tive for HR-HPV had over 35-fold increased risk of having high grade squamo us intraepithelial lesion (HSIL) or cervical cancer, although this does not necessarily translate into the same risk rate for women with latent HPV in fection developing major cervical neoplasia. HPV typing offers 90% sensitiv ity and 85% specificity for cervical cancer detection. In combination with cytology it provides a negative predictive value of 99.4% and a sensitivity of over 96% for detection of HSIL and cervical cancer. We conclude that HPV typing is an inexpensive and effective method for iden tification of cervical neoplasia and women at risk of developing it. It imp roves quality control for both false negative and false positive cytology r esults. Routine screening intervals could safely be increased to 3-5 years, decreasing anxiety and socio-economic inconveniences.