Repeat HPV testing for cervical cancer screening recommended

Chen HC. J Natl Cancer Inst. 2011;doi:10.1093/jnci/djr283.

A negative human papillomavirus test result was associated with a low long-term risk for cervical cancer, whereas persistent detection among normal cytological women significantly increased the risk. Researchers, therefore, recommend repeat testing after an initial positive test.

“In women older than 30 years who test positive for HPV, it is helpful to perform a repeated HPV test 2 years later to improve the predictive value and specificity of cervical cancer screening,” the researchers wrote. “The accumulated evidence suggests that it is time to include HPV testing in cancer screening programs for the general population. HPV-negative women will obtain superior reassurance of reduced risk.”

For the 16-year prospective study, Chien-Jen Chen, ScD, of the Genomics Research Center of Academia Sinica in Taipei, Taiwan, and colleagues examined the role of genotype-specific HPV persistence in predicting cervical cancer, including invasive cervical cancer and carcinoma in situ.

Chien-Jen Chen, ScD

A polymerase chain reaction–based assay detected 39 HPV types in 11,923 women aged 30 to 65 years. Women were tested for HPV during baseline examination between 1991 and 1992 and were re-examined 2 years later. Cancer and death registries were used to identify women who developed cervical cancer. Cumulative risks for developing cervical cancer among infected and persistently infected women were calculated.

Of 10,123 women who were initially cytologically normal, 68 developed cervical cancer before Dec. 31, 2006. The 16-year cumulative risk for developing cervical cancer was highest with HPV16 (13.5%). This was followed by HPV58 (10.3%) and other carcinogenic HPV types (4%) vs. 0.26% for HPV-negative women.

Women with type-specific persistence of carcinogenic HPV had a significantly increased risk for cervical cancer compared with women who were HPV-negative during the 2-year testing interval (HR=75.4; 95% CI, 31.8-178.9); the risk increased with age: 5.5%, 14.4% and 18.1% for women aged 30 to 44 years, 45 to 54 years and at least 55 years, respectively.

“We confirmed the critical role of persistent carcinogenic HPV infections in predicting risk of subsequent cervical neoplasia in women aged 30 years and older,” the researchers wrote. “The incidence of [invasive cervical cancer] or [carcinoma in situ] following baseline infection by the 12 carcinogenic HPV types was 0.37% per person-year, which was more than 20-times the risk in HPV-negative women. The extraordinary risk stratification of cervical cancer provided by HPV testing in this cohort supports the usefulness of HPV testing, at long intervals, for cervical cancer screening.”

Disclosure: This work was supported by the Bureau of Health Promotion, Department of Health (93-028) and the National Science Council (NSC 94-2314-B-001-011 and 95-2314-B-001-007; 96-2314-B-001-004 and 97-2314-B-001-001-MY3) in Taiwan.

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