The study by researchers from the UK and Spain found that urine tests may offer a ‘more accessible and acceptable method’ for detecting HPV, which could improve screening uptake among women reluctant to attend.
Screening for the presence of HPV in the cervix is being piloted as a new way of screening for women at risk of cervical cancer, and research suggests it may be more protective of precancerous cervical changes and invasive cervical cancer than current cytology-based screening methods.
However, cervical HPV detection is still invasive and time-consuming, researcher said, and is unlikely to improve uptake among women who may be deterred from attending for the procedure.
In the meta-analysis, published in The BMJ, the researchers assessed data from 14 studies involving 1,443 sexually active women. They looked at the accuracy of HPV testing using urine samples compared with HPV detection from conventional cervical smears.
Urine tests analyse DNA in the sample to detect the presence of HPV. Among women whose HPV status had already been determined by prior cervical testing, these urine tests correctly identified 87% of positive HPV cases and 94% of negative cases.
Test accuracy increased when samples were taken from the patient’s first urination of the day, as these contain a larger quantity of DNA than random or midstream sampling.
Benefit for hard-to-reach groups
Researchers said the results showed testing urine for HPV could ‘accurately replace cervical testing for HPV’. They suggested it could be particularly useful for targeting difficult-to-reach women.
The authors said it would be important to conduct further assessments before relying on the test to diagnose patients with an HPV infection.
They said: ‘Our review demonstrates the accuracy of detection of HPV in urine for the presence of cervical HPV. When cervical testing for HPV is sought, urine-based testing should be an acceptable alternative to increase coverage for subgroups that are hard to reach.
'However, results must be interpreted with caution owing to variation between individual studies for participant characteristics, lack of standardised methods of urine testing, and the surrogate nature of cervical HPV for cervical disease.’
Up to 80% of women are thought to be infected by one of the HPV strains at some point in their lives.
