HPV DNA testing recommended during cervical screening for 30-year-old women

Issue: January 2012

Implementation of human papillomavirus DNA testing in cervical screening led to earlier detection and treatment of cervical intraepithelial neoplasia when compared with cytology alone, according to new 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 of pathology at 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 Study Amsterdam (POBASCAM) trial, Meijer and colleagues set out to assess detection of HPV by DNA screening during two screening rounds, 5 years apart.

Between January 1999 and September 2002, women aged 29 to 56 years included in a cervical screening program were randomly assigned to the HPV DNA and cytology combined testing intervention or to a control group that included cytology testing alone, during the first screening. 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); CIN grade-3 cases did not differ between the groups.

During the second screening (5 years later), CIN grade 3 was less common in the intervention group vs. controls (88 of 19,579 vs. 122 of 19,731; RR=0.73; 95% CI, 0.55-0.96). Cervical cancer was also 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), and fewer HPV 16-positive CIN grade 3 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 CIN grade 2 and CIN grade 3 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 National Cancer Institute’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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