Testing found to be most beneficial in women 35 years and older compared with cytology-- A. Agrawal, PhD
Thursday, January 21, 2010 (Last Updated: 01/22/2010)
THURSDAY, Jan. 21 (HealthDay News) -- Screening women 35 and older for human papillomavirus (HPV) is more effective than conventional cytology in detecting invasive cervical cancers, while HPV screening in younger women leads to over-diagnosis of precancerous lesions that often regress, according to a study published online Jan. 19 in The Lancet Oncology.
In two rounds of screening, Guglielmo Ronco, M.D., from the Centre for Cancer Prevention in Turin, Italy, and colleagues randomly assigned women aged 25 to 60 to either conventional cytology or HPV testing plus cytology (phase one) or conventional cytology or HPV testing alone (phase two). During phase one, women 35 and older were referred for colposcopy if they were HPV positive, while women 25 to 34 were referred for colposcopy only if cytology was also abnormal or they were positive for HPV. During phase two, women in the HPV group were referred for colposcopy if they were positive for HPV.
In the first round of screening, the researchers found that the detection of invasive cervical cancers was similar. However, in the second round of screening, significantly fewer cases of invasive cancers were detected in the HPV group compared with the cytology group. In the two rounds of screening, there were significantly fewer invasive cancers detected in the HPV group. For women 35 and older, combining HPV testing with cytology did not increase the sensitivity of screening, while for younger women, HPV testing led to over-diagnosis and treatment of regressive cervical intraepithelial neoplasia 2 (CIN2) lesions.
"HPV-based screening is more effective than cytology in preventing invasive cervical cancer, by detecting persistent high-grade lesions earlier and providing a longer low-risk period," the authors conclude. "However, in younger women, HPV screening leads to over-diagnosis of regressive CIN2."
Authors of the study reported financial relationships with the pharmaceutical industry.
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