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HPV test alongside smear leads to earlier pre-cancer detection

HPV testing alongside smear tests leads to earlier detection and treatment of cervival pre-cancer, according to a large new study.

The observational study, carried out jointly by researchers from Queen Mary University of London and the University of New Mexico Comprehensive Cancer Centre, sourced data on over 20,000 patients with a borderline abnormal smear from the New Mexico HPV Pap Registry.

They then compared the outcomes for women who were followed up with smear tests only, and those who also had an HPV test, finding that the additional test led to a 15.8% overall increase in the detection of cervical pre-cancers. They also found that time to detection was much shorter at a median of 103 days compared to 393 days.

The researchers said their study was the first comprehensive evaluation of HPV testing ‘on the long-term outcomes of women who had received a borderline abnormal [smear test result]’.

They added: ‘Virtually all cervical pre-cancers were detected in women who tested positive for HPV, suggesting HPV testing to be a good additional screening method after the Pap smear. Colposcopy, which is a medical examination of the cervix, could then be focused on women who would need it most: those with a positive HPV test.’

But they warned that HPV testing resulted in 56% more biopsies – most of which were for low-grade lesions – and a 20% increase in surgical treatments indicating that it led to some overtreatment.

Professor Jack Cuzick, head of the Centre for Cancer Prevention at QMUL, said: ‘This study shows that knowing a woman’s HPV status can help determine her likelihood of needing additional procedures, and prioritise immediate treatment and medical resources to the women who need them most.’

It comes as the National Screening Committee (NSC) advised last year that the national NHS screening programme ‘should adopt HPV as a primary screen test as it is a more accurate screening test’.

Paper published in JAMA Oncology 22 June 2017


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