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HPV triage (reflex HPV testing) of low grade abnormalities has commenced (May 2015)

(07 May 2015)

Smear tests samples sent to programme laboratories that are reported as either ASCUS or LSIL will be reflex HPV tested for the presence or absence of certain HPV sub-types associated with cervical intraepithelial neoplasia (CIN).

HPV triage only applies to low grade cytological abnormalities. Smear tests reported as no abnormality detected, high grade abnormalities or unsatisfactory continue to be managed by cytology alone and there are no changes to current recommendations.

In 2014, 7% of women screened had a low grade abnormality. The range is likely to be between 4 and 10 for every 100 women screened by a smeartaker.

HPV triage is an important development in cervical screening. HPV triage will help to avoid unnecessary smear tests for some women while facilitating earlier diagnosis, and treatment where necessary, for other women.

All women attending for a smear test from May onwards should be advised that their sample may be tested for certain types of HPV infection. Doctors will begin to receive cytology AND HPV test results where the cytology is low grade abnormal from mid-May. Smeartakers should note the recommendations in advising women about their results.

As standard practice, a recommendation will accompany the laboratory’s result to the doctor. The recommendation will be routine re-call (3 or 5 years) when the HPV test is negative.  This reflects the low risk of developing high-grade CIN in that interval.

When the HPV test is positive, the recommendation will be refer to colposcopy. These women should be advised that they will require a further examination (a colposcopy) and possibly a biopsy to determine whether or not any disease (CIN) is present. When there is no CIN present, women will be discharged from colposcopy with a recommendation for a further smear test in 3 years, whatever their age.

The revised recommendations associated with cervical screening (cytology and HPV) test results were issued to all registered smeartakers in April and included the updated: 

These publications should replace all previous versions.

Note that the HPV test is a reflex test. A HPV test cannot be ordered with the CervicalCheck programme.

Further information about HPV triage is available via:

  1. Guidance note 14 - HPV testing in primary care
  2. CervicalCheck triage will lead to earlier detection, Drs. G Flannelly & C. Burns, GP Forum, April 2015 (reproduced with the kind permission of Forum, Medmedia Ltd.)
  3. eLearning module (accredited with CPD points) on the Screening Service learning portal, accessible from the health professionals section of CervicalCheck website, available in early June. Visit page and select CPD accredited courses. Registering is required if the learning portal has not been previously used.
  4. CervicalCheck website – Health professionals section
  5. CervicalCheck Programme Office at Freephone 1800 45 45 55.
Is cuid den tSeirbhís Náisiúnta Scagthástála é CervicalCheck
Bosca Oifig Phoist 161, Luimneach
Saorghlao 1800 45 45 55
CervicalCheck is part of the National Cancer Screening Service
PO Box 161 Limerick
Freephone 1800 45 45 55

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Is cuid den Rannóg Sláinte agus Folláine i bhFeidhmeannacht na Seirbhíse Sláinte í an tSeirbhís Náisiúnta Scagthástála. Cuimsíonn sí BreastCheck – An Clár Náisiúnta Scagthástála Cíoch, CervicalCheck – An Clár Náisiúnta Scagthástála Ceirbheacs, BowelScreen – An Clár Náisiúnta Scagthástála Putóige agus Diabetic RetinaScreen – An Clár Náisiúnta Scagthástála Reitiní do Dhiaibéitigh.

The National Screening Service is part of the Health and Wellbeing Division of the Health Service Executive. It encompasses BreastCheck – The National Breast Screening Programme, CervicalCheck – The National Cervical Screening Programme, BowelScreen – The National Bowel Screening Programme and Diabetic RetinaScreen – The National Diabetic Retinal Screening Programme.