HPV TESTING DOES NOT IMPROVE CERVICAL CANCER SCREENING WITH LPC

NEW YORK (Reuters Health) Jun 17 - The results of a UK study suggest that adding human papillomavirus (HPV) testing to liquid-based cytology (LBC) does not increased the accuracy of cervical cancer screening.

"The take-home message is that HPV will detect lesions not detected with cytology, but in this LBC trial, the added effect over cytology was small," lead author Dr. Henry C. Kitchener, from Manchester Academic Health Science Centre, told Reuters Health. "Routine co-testing with HPV and LBC for primary cervical screening is unlikely to be cost effective, and we would not recommend this."

Their current study is not the first to assess the benefit of HPV testing in cervical cancer screening, Dr. Kitchener said. "The novel aspect of our trial was that it used LBC. There have been two other similar randomized trials, but they used conventional cytology. LBC is now widely used in developed countries."

Known as the ARTISTIC trial, the investigation involved 24,510 women, 20 to 64 years of age, who were randomized to undergo screening with LBC and HPV testing in which the results were revealed and acted on, or to undergo LBC and HPV screening without revelation of the HPV result. Two rounds of screening were performed and the main outcome measure was the detection rate of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in the second round.

In the first round of screening, the rate of CIN3+ was nearly the same in each group, hovering around 1.29%, according to the report in June 18th online issue of The Lancet Oncology.

In the second round, the CIN3+ detection rates fell markedly in both groups, but to a greater extent in the HPV test-revealed group: 0.25% vs. 0.47% (p = 0.042).

However, when the results from both rounds were combined, the CIN3+ detection rate in the HPV test-revealed group was comparable to that in the control group: 1.51% vs. 1.77% (p > 0.02).

Regarding future research, Dr. Kitchener commented, "there are potential advantages of HPV over cytology as a single screening test, for example increased sensitivity and longer screening intervals, so new studies should address the optimal means of using HPV testing in primary cervical screening."

Lancet Oncol 2009.