Triage of HPV-positive women is crucial to differentiate women at increased risk of precancer from women with transient HPV infections.
Many triage strategies are currently being evaluated, including cytology, HPV genotyping, p16/Ki-67 dual stain cytology, various methylation markers, and combinations of these markers.
An ideal triage marker should identify the small group of women among the HPV-positives with high risk of precancer, while reassuring most women that risk of precancer is low. The evaluation of triage strategies needs to consider the primary screening approach and the setting (e.g. high-resource vs. low-resource; organized vs. opportunistic; physician collection vs. self-sampling). The absolute risk of precancer predicted by a triage test needs to be estimated in a population similar to which the assay will be used in. The risk thresholds, which determine what clinical action is taken given different assay results, may differ substantially between different settings. Consequently, it is important to compare different triage markers ideally in the same, but at least in very comparable populations with similar clinical management.
The presentation will introduce the design and rationale of the Improved Risk Informed HPV Screening (IRIS) Study that was designed to compare various triage strategies in a large HPV screening population.