HealthDay News — Combining human papillomavirus (HPV) DNA testing with cytology testing at first screening resulted in fewer cases of high-grade cervical intraepithelial neoplasia (CIN) lesions and cervical cancer at a second screening five years later, study findings indicate.
“Implementation of HPV DNA testing in cervical screening leads to earlier detection of clinically relevant [CIN] grade 2 or worse, which when adequately treated, improves protection against [CIN] grade 3 or worse and cervical cancer,” Dorien C. Rijkaart, MD, from the VU University Medical Center in Amsterdam, Netherlands, and colleagues wrote in Lancet Oncology.
Earlier studies have shown that HPV DNA testing is more sensitive than cytology, but whether or not it provides better protection against high-grade cervical lesions or cervical cancer over longer screening intervals is not known.
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So Rijkaart and colleagues enrolled women aged 29 to 56 years in the POpulation-BAsed SCreening study AMsterdam (POBASCAM) trial and randomly assigned them to receive HPV DNA with cytology co-testing (intervention) or cytology alone (control) at first HPV screen. Both groups underwent HPV DNA and cytology co-testing at a second screening five years later. Overall 16,750 women in the DNA testing group and 16,743 controls completed both screens.
CIN grade 3 or worse and cervical cancer were significantly less common in the intervention than control group upon second screening, the researchers found.
In the baseline screening round, women in the intervention group had significantly more cases of CIN grade 2 or worse (HR 1.25, 95% CI 1.05 to 1.5, P=0.015), but not grade 3 or worse. At the second screen, non-HPV16-positive CIN grade 3 or worse detection did not differ significantly between the groups (P=1.0), but the intervention group had significantly fewer incidence of HPV16-positive CIN grade 3 lesions or worse(HR=0.48, 95% CI:0.27-0.85, P=0.012).
When both screening rounds were combined cumulative detection of CIN grade 2 or worse and CIN grade 3 or worse was not significantly different between study groups (P=0.631).
“Our results lend support to the use of HPV DNA testing for all women aged 29 years and older,” the researchers wrote, adding that the study findings suggest that HPV DNA testing will not lead to overdiagnosis in younger women.
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.”
Katki and Wentzenson also pointed out the need for an effective protocol to determine which HPV-positive women would benefit most from coloposcopies, in order to prevent unnecessary biopsies and procedures.
Several authors disclosed financial relationships with the pharmaceutical industry. Several authors hold patents pertaining to HPV detection and cervical cancer.
Rijkaart DC et al. Lancet Oncol. 2011; doi:10.1016/S1470-2045(11)70296-0.
Katki HA, Wentzenson H. Lancet Oncol. 2011; doi:10.1016/S1470-2045(11)70334-5.
