HPV DNA Tests Should Be Included in Cervical Screening

Tests for the DNA of high-risk types of human papillomavirus (HPV) have a higher sensitivity for cervical intraepithelial neoplasia grade II or worse (CIN3+) than does cytologic testing.

A five- to six-year follow-up of a randomized control trial in the Netherlands involving over 7,000 women aged 29-56 years indicated that the implementation of HPV DNA testing in cervical screening leads to earlier detection of CIN3+ lesions. Earlier detection of such lesions could permit an extension of the screening interval.

Women who were participating in the regular cervical screening program in the Netherlands were randomly assigned to combined cytological and HPV DNA testing or to conventional cytological testing only. After five to six years, combined cytologic and HPV DNA testing were done in both groups. The primary outcome measure was the number of CIN3+ lesions detected.

The study appeared in the October 6, 2007, online issue of the journal Lancet. "Tests for the DNA of high-risk types of human papillomavirus have a higher sensitivity for cervical intraepithelial neoplasia grade III or worse [CIN3+] than does cytological testing, but the necessity of such testing in cervical screening has been debated,” wrote Prof. CJLM Meijer, from the VU University Medical Center (Amsterdam, the Netherlands) and colleagues. "Our aim was to determine whether the effectiveness of cervical screening improves when HPV DNA testing is implemented.”

The study authors noted that findings from ongoing randomized trials evaluating the long-term effect of HPV DNA testing should confirm whether the incidence of cervical lesions at the next screening round is sufficiently low in the HPV DNA testing group to permit extension of the screening interval. Cost-effectiveness analysis should help determine whether primary HPV DNA testing alone is the best strategy for primary cervical screening. They concluded, "Earlier detection of CIN3+ lesions could permit an extension of the screening interval.... On the basis of these data, we suggest that the current screening interval of five years could be extended by at least one year.”


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