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Objective: To evaluate, from a gynecology perspective, the transition from cytology-based HPV screening to primary HPV screening., Methods: Studies examining switching from cytology-based screening to primary HPV-DNA testing with triaging of patients with positive test results were retrieved and reviewed, with a particular focus on screening in an Italian setting., Results: The increased complexity of patient-management decisions when implementing HPV-based screening was a critical issue discussed in the literature. The change in strategy represents a paradigm shift in moving from a medical perspective of identifying the disease in individual patients, to a public-healthcare perspective of excluding HPV from the healthy population and identifying a small sub-group of individuals at increased risk of HPV., Conclusion: With knowledge about HPV screening evolving rapidly, new programs and related algorithms need to be sufficiently flexible to be adjusted according to ongoing research and the validation of new assays. The establishment of a national working group (including epidemiologists, gynecologists, pathologists, and healthcare providers) will be necessary to properly implement and govern this important technical and cultural transition., (© 2016 International Federation of Gynecology and Obstetrics.)

Objective: Strong evidences shows that HPV testing is more sensitive than cytology in detecting high-grade CIN. HPV test can be performed on samples collected by women themselves by means of self-sampling devices. This study compares the results of self-sampled HPV tests with the results of liquid based cytology (LBC)., Study Design: Seven hundred women scheduled for cervical cytology self-collected a cervicovaginal sample for HPV testing and then underwent a clinician-collected LBC at the European Institute of Oncology. The HPV and LBC results were compared with the McNemar test., Results: All HSIL (N=5) resulted hrHPV positive. LBC resulted LSIL or worse in 38 (5.4%) women (out of 700). Self-sampled HPV was positive in 96 women (13.7%). A LSIL or worse LBC result was found in 15 (2.5%) patients, out of the 604 hrHPV negative women and in 23 (24%) patients, out of the 96 hrHPV positive women. Positive cytology after a self-sampled HPV positive result had an Odds Ratio of 12.4 (95% CI: 5.8-26.6)., Conclusion: Self-collected HPV testing identifies a group of women at high risk of positive LBC and high grade SIL., (Copyright © 2014. Published by Elsevier Ireland Ltd.)

Although cervical cytology screening has dramatically reduced its incidence, cervical cancer still occurs. The clinical history of 261 cervical cancer patients referred to the European Institute of Oncology between 1996 and 2006 was analysed in depth to better understand the difficulties in the diagnosis and prevention of this neoplasia in Italy. Data concerning anagraphical characteristics, tumour type and stage, Pap smear history, colposcopic and histologic data, treatment outcome were reviewed. Patients who had taken Pap smear in the 3-year time span preceding diagnosis were 199 and 55 (27.7%) of these smears were negative. A negative Pap smear was observed in 62.5% of the women with a cancer at stage IV or III. One hundred and seventy-two patients were symptomatic at diagnosis: 43 (25%) had a negative Pap smear in the 3 years preceding diagnosis while 54 (31.4%) had never done a Pap smear or had one taken more than 3 years before. Eighty-nine women were asymptomatic at the time of diagnosis; 13 patients (14.6%) had a negative Pap smear while 8 had no smear taken in the 3 years preceding diagnosis or no smear at all. The present retrospective investigation indicates that the screening system still has some critical points. Although multiple techniques and approaches have been proposed to improve the general performance of the system, prophylactic vaccination may dramatically limit the failures in an easier, and possibly more cost-effective way. We also stress that history taking and clinical examination are important tools to diagnose cervical cancers. However a clinical diagnosis requires experience, which, with the advent of more efficient screening system and prophylactic vaccination, many of the newer practising gynaecologists might lack.