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HPV testing recommended for all women over 30

Robin Wulffson MD's picture
human papillomavirus, HPV, HPV testing, cervical cancer, CIN, Pap smear

LONDON, ENGLAND - According to a new study published online in the journal Lancet Oncology on December 15, all women over 30 should undergo human papillomavirus (HPV) testing. The study authors noted that HPV testing is more sensitive for the detection of high-grade cervical lesions than is cytology; however, detection of HPV by DNA screening in two screening rounds five years apart had not been assessed prior to their study. The aim of the study was to assess whether HPV DNA testing in the first screen decreases detection of cervical intraepithelial neoplasia (CIN) grade 3 or worse, CIN grade 2 or worse, and cervical cancer in the second screening.

Dr. Chris Meijer and colleagues from the VU University Medical Centre in Amsterdam noted that new DNA tests, which can identify the virus responsible for most cases of cervical cancer, should be given to all women aged 30 or over because they can prevent more cases of cancer than Pap smears alone. In recent years, tests for high-risk HPV strains have been developed by companies including Roche and Qiagen. The new tests are known to work well in detecting HPV; however, the Dutch study is the first to report that they are better than Pap smears alone over two screening rounds set five years apart.

The results of the five-year study comprised of 45,000 women yielded the strongest evidence to date in favor of using human papillomavirus (HPV) testing. The women were randomly assigned to receive HPV DNA (GP5+/6+-PCR method) and cytology (Pap smear) co-testing or cytology testing alone, from January, 1999, to September, 2002. At the second screening five years later, HPV DNA and cytology co-testing was done in both groups; researchers were unaware of f which patients received both tests (double-blind study). The primary study endpoint was the number of CIN grade 3 or worse detected. (CIN refers to cervical intraepithelial neoplasia; higher CIN grades are more cancerous.)

HPV Test Results

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The researchers found that the use of HPV tests resulted in earlier detection of pre-cancerous lesions, allowing for treatment that improved protection against cancer. Doctors Hormuzd Katki and Nicolas Wentzensen from the U.S. National Cancer Institute noted that the results reinforced earlier findings, and provided "overwhelming evidence" of the benefits of including HPV testing in cervical screening programs.

The government-backed U.S. Preventive Services Task Force currently urges women who have been sexually active and have a cervix to get Pap smears at least every three years. However, the group recommends against routinely screening women over 65 if they had normal results on a recent Pap smear.

Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of routine use of Pap smears. The development of cervical cancer is usually very slow. It starts as a precancerous condition called dysplasia (CIN grading). This precancerous condition is 100% treatable. That is why it is so important for women to get regular cervical screening. Undetected, precancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. It can take years for precancerous changes to turn into cervical cancer. Patients with cervical cancer do not usually have symptoms until the cancer is advanced and has spread.

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