'Wait and see' policy' suggested for women with abnormal cervical smears in presence of high-risk human papillomavirus

November 22, 2001

N.B. Please note that if you are outside North America please note that the embargo for Lancet press material is 0001 hours UK Time Friday 23 November 2001.

Women with abnormal cervical smears (mild to moderate dyskaryosis) and who are positive for the high-risk form of human papillomavirus (HR-HPV) should not be treated for at least 6 months after cytological screening to see if the virus disappears, suggest authors of a research letter in this week's issue of THE LANCET. If viral clearance occurs, this is likely to result in a return to normal cervical-cell appearance and could prevent women from being overtreated.

Only a small proportion of women infected with HR-HPV develop cervical cancer, and most premalignant lesions regress; this often results in women being overtreated-often leading to the unnecessary surgical removal of the transformation zone of the cervix-when they are identified as having abnormal smears and HR-HPV. Chris Meijer from Vrije Universiteit Medical Centre, Amsterdam, Netherlands, and colleagues used data from a previous study to find out whether clearance (disappearance) of HR-HPV could predict cytological regression of premalignant cervical cells.

353 women were referred for colposcopy (visual study of the cervix) because of abnormal smear-test results. The investigators found that HR-HPV clearance preceded regression of cervical lesions by an average of 3 months. The cumulative 1-year rate of cytological regression was similar in women with mild and moderate abnormal cervical smears. They conclude that retesting of HR-HPV after 6 months in women with mild to moderate dyskaryosis predicts cytological regression. When abnormal smears were found in the absence of HR-HPV the cumulative incidence of cytological regression after 4 years was 100%.

Chris Meijer comments: "We suggest that overtreatment in women with abnormal smears could be prevented by implementing HR-HPV testing. When HR-HPV is absent in abnormal cervical smears no treatment is advocated, because these smears will always become normal. In case HR-HPV is present we advice a 'wait and see' period for at least six months to allow high-risk HPV clearance and subsequent regression of the lesion. However, the time-interval until retesting should be traded off against the chance of regression and of developing malignancy."
Contact: Professor Chris Meijer, Department of Pathology, Vrije Universiteit Medical Centre, PO Box 7057, 1007 MB, Amsterdam, Netherlands; T) +31 20 444 4070; F) +31 20 444 2964; E) cjlm.meijer@vumc.nl


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