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ADDING HPV TESTING TO CERVICAL SCREENING COULD SAVE LIVES AND SAVE MONEY

September 09, 1999

Adding a test for a virus known to cause cervical cancer to the conventional cervical smear test improves the detection of cervical abnormalities in women over 34 years old. Research published today1 shows that the use of a test for the human papilloma virus (HPV) in addition to the current Pap smear increases the number of high-grade pre-cancerous lesions detected and decreases the number of such lesions which are missed.

The research team, led by Professor Jack Cuzick, Head of the Mathematics, Statistics and Epidemiology unit at Imperial Cancer Research Fund, was building on previous work which has shown that the HPV test can improve the pick-up rate of cervical abnormalities in younger women2. However, over 80% of cervical cancers occur in women over 35 years old and so looking at the benefits of the test in this older group was particularly important. It is also believed that the HPV virus, if present in these women, is more likely to be persistent and therefore has a much higher risk of leading to cervical cancer.

Professor Jack Cuzick said:

"Virtually all cases of cervical cancer are positive for HPV. By testing for the presence of this virus, the detection of cervical disease is improved and there is the potential to save even more lives than with the current screening programme. It might also be possible to safely extend the screening interval for women who are HPV negative and so also reduce the costs of cervical screening.

Professor Cuzick continues:

"Previous studies have shown that HPV testing has a higher detection rate than conventional screening, but they have been predominantly carried out in younger women. However, in younger women, most of the HPV infections are short-lived and don't lead to disease, which means that HPV testing in this group can lead to a high false positive rate. This study looked specifically at the effectiveness of the HPV test in older women and the results would suggest that the introduction of this test, as an addition to the Pap smear, would be beneficial. In addition, the overall evidence suggests that testing for HPV could be very helpful for the management of borderline smears for women of all ages, as a positive HPV test would highlight which of these women needed further investigations."

Professor Pat Soutter, consultant gyncaecologist at the Hammersmith Hospital where the study was conducted, added:

"The current National Cervical Screening Programme saves approximately 1,300 lives each year. However, we are still looking at ways in which it could be improved. This trial has shown that there are potential benefits to the use of a highly sensitive HPV test in older women. What we really need now, is a large scale demonstration trial to confirm these findings in the context of a screening programme, which would also enable us to see whether the screening interval can be increased."

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1. Cuzick , J et al (1999) HPV testing in primary screening of older women. British Journal of Cancer vol 81 (3) , 10th September 1999.

2. Cuzick J et al (1995) Human papilloma virus testing in primary cervical screening. Lancet 345: 1533-1537.


ENDS



Wellcome Trust, The