HPV testing for cervical screening investigated

New research, published in The Lancet Oncology, has found that combining human papillomavirus (HPV) testing with routine liquid-based cytology (LBC) screening does not increase the detection of cervical cancer compared with LBC screening alone. The trial funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme aimed to determine whether testing for HPV in the cervix might increase the effectiveness of the cervical screening programme.

Cervical cancer is the second most common cancer in women under 35 years old, with about 2,800 women overall being diagnosed each year in the UK leading to about 1,000 deaths. Current screening relies on cervical smear tests processed with LBC and prevents around 70 per cent of cervical cancers. Previous research has indicated that HPV testing might help identify additional cases that are not detected by smears.

The £1.4 million study led by Professor Henry Kitchener, University of Manchester, is the first to compare the addition of HPV testing to cytology with cytology alone in primary cervical screening. More than 24,000 women were recruited for the study and given an HPV test. They were then randomly assigned to have their HPV result either revealed and acted on or concealed while they continued with standard treatment. Women in the revealed group who were HPV positive and had a negative smear were retested after 12 months and treatment was offered if necessary. All women were invited for a second screening test 36 months after they attended their first screen.

Overall, over the two screening rounds the addition of an HPV test to cytology did not lead to the detection of more high-grade lesions than cytology alone. Although the findings suggest there was no additional benefit when combining cytology with HPV testing, the NIHR HTA programme has agreed to fund the trial for a further three years to determine whether it would be possible for screening intervals to be extended in those with a negative HPV test. For more information visit www.hta.ac.uk/1710

"The results of our trial should help bring clarity to this area and inform the further development of national policy on the role of HPV testing and the NHS cervical screening programme," says Professor Kitchener, "and with three further years of research we hope to be able to add to this evidence and address issues such as the psychological impact of HPV testing and its cost-effectiveness."

To view The Lancet Oncology paper visit http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(09)70156-1/fulltext.