HPV testing an important part of cervical cancer screening

January 01, 0001

HPV testing an important part of cervical cancer screening

Concurrent testing for human papillomavirus (HPV) and cervical cytology (co-testing) is an approved alternative to cytology alone in women aged 30 years and older. The researchers from the USA aimed to assess the safety in routine clinical practice of 3-year screening intervals for women testing negative for HPV with normal cytology and to assess if co- testing can identify women at high risk of cervical cancer or cervical intraepithelial neoplasia grade 3 (CIN3) or worse over 5 years. They assessed the 5-year cumulative incidence, starting in 2003—05, of cervical cancer and CIN3 or worse for 331,818 women aged 30 years and older who enrolled in co-testing at Kaiser Permanente Northern California (Berkeley, CA, USA) and had adequate enrolment co-test results. Follow-up continued until Dec 31, 2009.

In 315,061 women negative by HPV testing, the 5- year cumulative incidence of cancer was 3.8 per 100,000 women per year, slightly higher than for the 306,969 who were both negative by HPV and Pap testing (3.2 per 100,000), and half the cancer risk of the 319,177 who were negative by Pap testing (7.5 per 100,000). 99.5% of women negative by HPV testing had either normal cytology or equivocal abnormalities. Abnormal cytology greatly increased cumulative incidence of CIN3 or worse over 5 years for the 16757 positive by HPV testing (12.1% vs 5.9%; significant). By contrast, although statistically significant, abnormal cytology did not increase 5- year risk of CIN3 or worse for women negative by HPV testing to a substantial level (0.86% vs 0.16%). 73% of the women positive by HPV testing had no cytological abnormality, and these women had 35% of 747 CIN3 or worse, 29% of 87 cancers, and 63% of 27 adenocarcinomas.

The researchers concluded: "For women aged 30 years and older in routine clinical practice who are negative by co-testing (both HPV and cytology), 3-year screening intervals were safe because a single negative test for HPV was sufficient to reassure against cervical cancer over 5 years. Incorporating HPV testing with cytology also resulted in earlier identification of women at high risk of cervical cancer, especially adenocarcinoma. Testing for HPV without adjunctive cytology might be sufficiently sensitive for primary screening for cervical cancer."

It is reassuring to see screening becoming more accurate and the appropriate timing becoming better defined.

For the full abstract, click here.

The Lancet Oncology 12(7):663-672, July 2011 © 2011 Elsevier Limited
Cervical cancer risk for women undergoing concurrent testing for human papillomavirus and cervical cytology: a population-based study in routine clinical practice. Hormuzd A Katki, Walter K Kinney, Barbara Fetterman. Correspondence to Hormuzd Katki: [email protected]

Category: X. Female Genital System, Breast. Keywords: cervical, cancer, risk, co-testing, cytology, human pappillomavirus, population-based study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 12 July 2011

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