HPV tests 'outperform smears', study says

HPV screening can detect more pre-cancerous cells of the cervix than smear tests, research suggests.

Research suggests switching primary screening from smears to HPV tests (Photograph: SPL)
Research suggests switching primary screening from smears to HPV tests (Photograph: SPL)

Finnish researchers showed that a HPV DNA test, followed by cytology triage, may be more sensitive than conventional cytology in detecting severe pre-cancerous lesions.

The authors said the findings may be important for the prevention of cervical cancer.

Previous research had suggested HPV screening may be a way to improve detection of pre-cancerous lesions, which can progress into cervical cancer.

A total of 58,076 women aged 30-60 were invited for cervical cancer screening. Researchers randomly assigned them to either a HPV DNA test, with cytology triage if the result was positive, or a conventional smear test.

The researchers looked for incidence of cervical intraepithelial neoplasia (CIN) grade III and adenocarcinoma in situ (CIN III+) as clinical outcomes.

Over five years, 129 cases of CIN III+ were detected, of which 14 were cervical cancers.

Among all women invited for screening, the HPV test and subsequent cytology was 44% more likely to detect CIN III+ than conventional screening. This rose to 77% among women who attended.

The study authors concluded: ‘Considering the high probability of progression of CIN III lesions in women aged 35 and over, our results are important for the prevention of cervical cancer.'

Writing in the BMJ, they recommended gradual implementation of HPV screening outside of Finland.

Meanwhile, a study published in the British Journal of Cancer found that women with HPV negative results had a lower rate of developing pre-cancerous (CIN II+) cells for at least six years compared with women who recorded a negative cytology result.

Study author Professor Jack Cuzick of Queen Mary, University of London said that using HPV testing as the primary screening method for cervical cancer would mean women could be screened less often and also create efficiency savings for the NHS.

He added: ‘There is now an overwhelming case for moving to HPV as the primary screening test for women 30 and over and demonstration projects should start for this now.'

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