HPV screening beats cytology for cervical cancer

HPV screening – with or without cytology triage for positive tests – is ‘promising' as a technique for cervical cancer screening among women aged 30 and over, but requires investigation through large long term trials.

Researchers from the United States made this conclusion after conducting a systematic review of evidence concerning three techniques for screening: conventional cytology, liquid cytology and HPV testing.

They found that one-time HPV testing was more sensitive than cytology for detecting cervical intraepithelial neoplasia (CIN3+/CIN2+), but was less specific. For CIN3 outcomes, point estimates sensitivity ranged from 86-97% for HPV testing, compared to 46-50% for cytology. The overall harm and cost of work-up for false-positive HPV test results were unclear.

Co-author Dr Evelyn Whitlock, a senior investigator at the Center for Health Research, Kaiser Permanente Northwest, Oregon, USA, said: ‘Substituting a strategy of primary HPV screening, with or without cytology triage is appealing, but important details remain unclear, including how much early disease detection is improved…and whether there would be a beneficial effect on invasive cervical cancer.'

The UK is rolling out an HPV ‘triage and test of cure' programme. Where triage is implemented, any woman with a cervical screening test result of borderline changes or mild dyskaryosis will automatically have an HPV test performed. Additionally a ‘test of cure' is used for women who have had treatment for CIN; HPV tests are carried out on samples from women who have a normal, borderline or mild screening test result.

Annals of Internal Medicine 2011, online 17 October