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HPV Screen Detects Lesions Earlier than Pap Test
 
 
  By Kristina Fiore, Staff Writer, MedPage Today
Published: December 14, 2011

DNA testing for human papillomavirus (HPV) picks up precancerous lesions earlier and prevents more cervical cancer than standard cytology screening alone, researchers found.

In a large randomized trial, patients who had HPV DNA testing plus regular cytology had more low-grade cervical intraepithelial neoplasias than those who only had cytology testing, Chris Meijer, MD, of VU University Medical Center in Amsterdam, and colleagues reported in The Lancet Oncology.

But at follow-up screening five years later, they had fewer high-grade lesions and cervical cancers, the researchers found.

"Implementation of HPV DNA testing in cervical screening leads to earlier detection of clinically relevant [neoplasia] grade 2 or worse, which when adequately treated, improves protection against [neoplasia] grade 3 or worse and cervical cancer," they wrote.

Action Points

· Explain that a large Dutch study found that adding human papillomavirus (HPV) DNA testing to cytology increased initial detection of grade 2 or higher cervical intrapithelial neoplasia but significantly decreased high-grade neoplasia and cervical cancer at a second screening 5 years later compared to cytology screening alone.

· Note that the investigators attributed the difference to early detection of HPV-16 lesions.

Studies have shown that HPV DNA testing is more sensitive for detecting cervical lesions than cytology, but whether it can better protect against high-grade cervical lesions or cervical cancer over a longer screening interval isn't known.

So Meijer and colleagues conducted the POpulation-BAsed SCreening study AMsterdam (POBASCAM) trial of women ages 29 to 56 in the Netherlands cervical screening program between January 1999 and September 2002. The women were assigned to either HPV DNA testing plus cytology, or to cytology alone.

All patients had subsequent HPV DNA testing plus cytology at a second screening five years later. In all, 16,750 women in the DNA testing group and 16,743 controls completed both screens.

During the first round of testing, the detection of neoplasia grade 3 or worse didn't differ significantly between groups, but there were significantly more cases of neoplasia grade 2 or worse in those who had the DNA testing (HR 1.25, 95% CI 1.05 to 1.5, P=0.015).

Yet in the second screening round five years later, there were significantly fewer high-grade neoplasias and cervical cancers in the initial DNA testing group (RR 0.73, 95% CI 0.55 to 0.96, P=0.023 and RR 0.29, 95% CI 0.10 to 0.87, P=0.031, respectively).

Meijer and colleagues said the improved protection was driven by the early detection of high-grade cervical lesions caused by HPV16, one of the most common strains of the virus.

For instance, at follow-up screening, those who initially had DNA testing had significantly fewer HPV16-positive neoplasia grade 3 or worse than controls (HR 0.48, 95% CI 0.27 to 0.85, P=0.012).

When both screening rounds were combined, there was no difference in the cumulative detection of neoplasia of any grade, the researchers added, noting that the finding held true when stratified by those ages 29 to 33, and those above age 33.

That suggests that HPV DNA testing won't lead to overdiagnosis in younger women, they wrote, and that screening programs could begin at age 30.

In an accompanying editorial, Hormuzd Katki, MD, and Nicolas Wentzensen, MD, of the National Cancer Institute, wrote that the findings provide "overwhelming evidence of the benefits of inclusion of HPV testing in screening programs."

The trial also shows that a five-year screening interval is safe, they wrote, and that "conservative management of HPV-positive women can control excess cervical intraepithelial neoplasia grade 2 or 3 while preventing cervical cancer."

They also called for an effective protocol that can help determine which HPV-positive women would most benefit from colposcopy, in order to prevent unnecessary biopsies and procedures.



 
 
 
 
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