Using human papillomavirus (HPV) DNA testing detects the lesions which lead to cervical cancer earlier than do conventional cytological techniques; this earlier detection could allow the screening interval to be extended. These are the conclusions of authors of an Article published early Online and in an upcoming edition of The Lancet.
Professor Chris Meijer, VU University Medical Centre, Amsterdam, Holland, and colleagues studied 17155 women aged 29 to 56 years participating in the regular cervical screening programme in the Netherlands. Of these, 8575 were assigned to HPV DNA testing to detect the high-risk types of human papillomavirus which can cause cervical cancer, while 8580 had conventional cytological testing. Five years later both cytological and DNA testing was done in both groups.
While it was already known that HPV DNA testing detects more CIN lesions, it was not clear until now whether or not these lesions were indeed relevant (non-regressive) cancer precursors. The researchers found that more CIN3+ lesions (cervical cancer and its most serious precursor lesions) were detected in the women given HPV DNA testing (68/8575 positive results) compared with the conventional cytological testing group (40/8580). Five years later, fewer women were detected with CIN3+ lesions in the HPV DNA group (24/8413) compared with the cytological testing group (56/8456). Thus, while of the number of patients with CIN3+ lesions detected over the two rounds did not differ between the groups, these lesions were detected earlier in the HPV DNA testing group.
The authors say: "Our results show that implementation of HPV DNA testing in cervical screening leads to earlier detection of clinically relevant cervical lesions. On the basis of this data, we suggest that the current screening interval of five years could be extended by at least one year. The extension will be advantageous to women because of a reduction in the lifetime number of screening tests and referrals."
They conclude: "A full cost-effectiveness analysis will help to determine whether primary HPV testing alone is the preferred strategy for primary cervical screening."
In an accompanying Comment, Drs Guglielmo Ronco and Nereo Segnan. Unit of Cancer Epidemiology, CPO Piemonte, Torino, Italy say: "The much lower risk of CIN3+ lesions seen in women classified as screen-negative in the experimental group than in the control group shows that extended screening intervals will be safe with HPV-DNA testing." They add that such longer intervals will not only reduce the cost of screening but also the burden for women, as well as improving participation, which is crucial since "non-participation [in screening] is still the most important reason for later development of cervical cancer in most developed countries."
Contacts
For Professor Chris Meijer, VU University Medical Centre, Amsterdam, Holland, please contact Mrs M Bolluijt, Head of Press/Communications Department T) +31 20 4443444 E) cjlm.meijer@vumc.nl
Dr Guglielmo Ronco, Unit of Cancer Epidemiology, CPO Piemonte, Torino, Italy T) +39 3357553701 E) guglielmo.ronco@cpo.it
Journal
The Lancet