HPV testing 'more predictive in older women'
By Lilian Anekwe
HPV testing is a useful way to triage older women with borderline cervical abnormalities but is less helpful for the under 40s, a major UK study concludes.
TOMBOLA, a multicentre randomised controlled trial run within the NHS cervical cancer screening programmes of 4,439 women aged 20-59 years with borderline nuclear abnormalities, randomised women to either six-monthly cytological screening in primary care or referral for colposcopy depending on their HPV status. The women were then followed up for three years.
Results showed that sensitivity decreased with age whereas specificity increased and was highest in women aged 40 to 59, at 86.5% for detecting cervical intraepithelial neoplasia (CIN) grade 2 or worse and 86.4% at CIN grade 3 or worse.
The negative predictive values were also highest in this age group, at 96.8% for detecting CIN2 or worse and 100% for CIN3 or worse.
Study lead Professor Norman Waugh, chair in public health medicine at the University of Aberdeen concluded: ‘On the basis of these results from a large RCT, we conclude that a single test HPV test would not be helpful in guiding management in women aged 40 or less, or for determining the most effective management at colposcopy.
‘However, a single HPV test could be useful as a guide to management in older women.'
HPV testing for women with borderline cervical abnormalities is being trialled at sentinel sites across England and Wales as part of the cervical screening programme.
Julietta Patnick, director of the NHS Cancer Screening Programmes said that the relative benefits of HPV testing among different age groups were being monitored at the sites.
But she suggested the programme was unlikely to opt for an age-stratified approach to HPV triage: ‘In the sentinel sites we apply HPV triage to all age groups and monitor the results. We will take these - and the results from TOMBOLA - into account in deciding policy but in terms of practical screening we generally try to keep things as simple as possible,´ she said.
Dr Anne Szarewski, head of HPV and cervix studies at the Wolfson Institute of Preventive Medicine at Barts and the London School of Medicine and Dentistry in London said because the TOMBOLA trial had started more than a decade ago, it employed different testing methods from those currently used so was of limited help in determining current policy.HPV testing 'more predictive in older women'