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Firming up the Benefits of Cervical HPV Detection

Compared with cytology alone, performing human papillomavirus DNA testing plus cytology led to fewer high-grade cervical lesions 5 years later.

The optimal implementation of human papillomavirus (HPV) detection for preventing cervical cancer is under debate. Now, Dutch investigators report final results of a population-based study (JW Womens Health Oct 25 2007) in which women (age range, 29–56) were randomized to undergo HPV DNA testing plus cervical cytology (intervention) or cytology alone (control); 5 years later, all women underwent HPV DNA testing plus cytology. Almost 50,000 women were initially randomized; of these, 39,000 participated in the second round of screening.

In the second screen, cervical intraepithelial neoplasia grade 3 or worse (CIN 3+) was less common among women who initially received HPV testing (88 vs. 122 women; relative risk, 0.73; P=0.023). In addition, only 4 women in the intervention group had invasive cervical cancer, compared with 14 in the control group (RR, 0.29; P=0.031). The lower rates of cancer in the intervention group at 5 years reflected more-frequent detection (and subsequent treatment) of cervical abnormalities in this group at baseline screening. Results were similar among younger and older women (age ranges, 29–33 and 34–56).

Comment: These results support the use of human papillomavirus testing combined with cytology for preventing cervical cancer. Importantly, the study was performed in a country in which routine cervical screening starts at age 29 and is conducted every 5 years thereafter. As such, direct application of these results to the U.S. is difficult because of differences in age at first testing (younger in the U.S.) and frequency of testing (higher). Similar data would be difficult to obtain in the U.S., where the shorter screening interval would probably abrogate the advantage conferred by HPV testing. However, the paradigm of HPV testing plus cytology at longer intervals is less expensive than the current approach, and therefore might be pursued as part of the mandate for comparative-effectiveness trials.

— Anna Wald, MD, MPH

Published in Journal Watch Women's Health January 26, 2012

Citation(s):

Rijkaart DC et al. Human papillomavirus testing for the detection of high-grade cervical intraepithelial neoplasia and cancer: Final results of the POBASCAM randomised controlled trial. Lancet Oncol 2012 Jan; 13:78.

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