Women with abnormal cervical smears (mild to moderate dyskaryosis) and who are positive for the high-risk form of human papillomavirus (HR-HPV) should not be treated for at least 6 months after cytological screening to see if the virus disappears, suggest authors of a research letter in this week’s issue of THE LANCET. If viral clearance occurs, this is likely to result in a return to normal cervical-cell appearance and could prevent women from being overtreated.
Only a small proportion of women infected with HR-HPV develop cervical cancer, and most premalignant lesions regress; this often results in women being overtreated-often leading to the unnecessary surgical removal of the transformation zone of the cervix-when they are identified as having abnormal smears and HR-HPV. Chris Meijer from Vrije Universiteit Medical Centre, Amsterdam, Netherlands, and colleagues used data from a previous study to find out whether clearance (disappearance) of HR-HPV could predict cytological regression of premalignant cervical cells.
353 women were referred for colposcopy (visual study of the cervix) because of abnormal smear-test results. The investigators found that HR-HPV clearance preceded regression of cervical lesions by an average of 3 months. The cumulative 1-year rate of cytological regression was similar in women with mild and moderate abnormal cervical smears. They conclude that retesting of HR-HPV after 6 months in women with mild to moderate dyskaryosis predicts cytological regression. When abnormal smears were found in the absence of HR-HPV the cumulative incidence of cytological regression after 4 years was 100%.
Chris Meijer comments: “We suggest that overtreatment in women with abnormal smears could be prevented by implementing HR-HPV testing. When HR-HPV is absent in abnormal cervical smears no treatment is advocated, because these smears will always become normal. In case HR-HPV is present we advice a ‘wait and see’ period for at least six months to allow high-risk HPV clearance and subsequent regression of the lesion. However, the time-interval until retesting should be traded off against the chance of regression and of developing malignancy.”
Contact: Professor Chris Meijer, Department of Pathology, Vrije Universiteit Medical Centre, PO Box 7057, 1007 MB, Amsterdam, Netherlands; T) +31 20 444 4070; F) +31 20 444 2964; E) cjlm.meijer@vumc.nl
Journal
The Lancet