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HPV DNA testing recommended during cervical screening for 30-year-old women
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Implementation of HPV DNA testing in cervical screening led to earlier detection and treatment of cervical intraepithelial neoplasia when compared with cytology alone, according to findings published in The Lancet Oncology.
“Early detection of high-grade cervical legions caused by HPV 16 was a major component of this benefit,” Chris Meijer, MD, professor from VU University Medical Centre in the Netherlands, and colleagues wrote in the study. “Our results lend support to the use of HPV DNA testing for all women aged 29 years and older.”
For the Population-Based Screening Amsterdam (POBASCAM) trial, Meijer and colleagues set out to assess detection of HPV by DNA screening during two screening rounds that were 5 years apart.
The study, which took place between January 1999 and September 2002, included women aged 29 to 56 years.
For the first screening, the women were randomly assigned to the HPV DNA and cytology combined testing intervention or to a control group that included cytology testing alone. Both groups received HPV DNA and cytology combined testing during the second screening.
During the first screening, significantly more cases of cervical intraepithelial neoplasia (CIN) grade 2 were observed in the intervention group vs. controls (267 of 19,999 vs. 215 of 20,106; RR=1.25; 95% CI, 1.05-1.50). CIN3 cases did not differ between the groups.
During the second screening, CIN3 was less common in the intervention group vs. controls (88 of 19,579 vs. 122 of 19,731; RR=.73; 95% CI, 0.55-0.96). Cervical cancer also was less common in the intervention group vs. controls (four of 19,579 vs. 14 of 19,731; RR=0.29; 95% CI, 0.10-0.87). Fewer HPV 16-positive CIN3 or worse were detected in the intervention group vs. controls (17 of 9,481 vs. 35 of 9,354; RR=0.48, 95%CI, 0.27-0.85), according to the study.
Cumulative detection of CIN2 and CIN3 across both screening rounds did not differ between women aged 29 to 33 years and women aged 34 years or older. Therefore, “HPV screening does not have to be postponed until patients reach age 35 years, but can be implemented at age 30 years,” the researchers wrote.
In an accompanying editorial, Hormuzd A. Katki, PhD, and Nicolas Wentzensen, MD, PhD, both of the NCI’s division of cancer epidemiology and genetics, wrote: “The POBASCAM trial shows that 5-year screening intervals are safe, and that conservative management of HPV-positive women can control excess CIN grade 2 or 3 while preventing cervical cancer. However, how the POBASCAM protocol would perform in other populations that have different baseline cancer rates, compliance and management infrastructure is unclear. Clinical management based on a woman’s individual risk of cervical cancer might account for population-specific factors that can have a substantial effect on the performance of screening protocols.”
For more information:
- Katki HA. Lancet Oncol. 2011;doi:10.1016/S1470-2045(11)70334-5.
- Rijkaart DC. Lancet Oncol. 2011;doi:10.1016/S1470-2045(11)70296-0.
Disclosure: This research was funded by Zorg Onderzoek Nederland (Netherlands Organization for Health Research and Development).
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This study demonstrates the value of HPV testing in detecting high-grade dysplasia and potentially preventing progression of pre-malignant abnormalities to cervix cancer. Further, the study strongly supports the combined role of cytology and HPV testing in screening for cervix cancer. It remains to be determined if the overall incidence of invasive cervix cancer will be reduced by routine HPV testing, and the issue of cost is a concern with this strategy.
– Maurie Markman, MD
HemOnc Today Editorial Board member
Disclosure: Dr. Markman reports no relevant financial disclosures.