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Evidence backs HPV test in cervical screening

Government cervical screening advisers are weighing up fresh evidence for carrying out human papillomavirus testing alongside liquid-based cytology in the UK.

New US research suggests screening for HPV in addition to liquid-based cytology every three years in women over 30 is more effective than screening with liquid-based cytology alone.

A team at Harvard University School of Public Health developed a computer-based model to compare the cost-effectiveness of a range of cervical cancer screening strategies.

The model – which simulates the natural history of cervical carcinogenesis – was used to find the best combination of liquid-based cytology versus conventional cytology, use of HPV testing and frequency of screening.

Liquid-based cytology every three years with HPV testing reserved for women with abnormal smears cut lifetime cervical cancer risk by 90 per cent compared with 84.6 per cent for conventional smear tests.

But adding HPV testing to annual liquid-based screening in women over 30 boosted the lifetime risk reduction to 93.4 per cent.

The most cost-effective screening programme was to screen women over 30 with the combined strategy but only every three years, the researchers concluded.

The new findings follow UK research involving 11,000 women in 161 GP practices that suggested HPV testing should become the main method of screening for cervical cancer.

Julietta Patnick, director of NHS Cancer Screening Programmes, said a final decision on UK policy would not be made until the completion of several HPV test trials currently under way: 'We are committed to investigating and implementing new technologies which may benefit women attending for screening but at present, further evidence on the utility of HPV testing is needed.'

Dr Muir Gray, director of the national screening committee, said HPV testing had a 'part to play in identifying risk' and the committee would continue to discuss the possibility of its inclusion.

lA Health Technology Assessment on the value of HPV testing alongside liquid-based cytology screening is being carried out in 25,000 women who have been called for routine smear tests and results of HPV as a triage screening test will be available later this year.

By Emma Wilkinson

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