HPV testing best cervical screening option for all women over the age of 30

December 14, 2011

Human papillomavirus (HPV) DNA testing is the best cervical cancer screening option for all women over the age of 30, detecting the lesions which lead to cervical cancer earlier and preventing more cervical cancer than cytology alone. The final results of the POBASCAM trial, published Online First in The Lancet Oncology, provide the strongest evidence so far in favour of using HPV testing in national screening programmes.

"POBASCAM reinforces findings from cohort studies, clinical trials, and routine clinical practice by providing overwhelming evidence of the benefits of inclusion of HPV testing in screening programmes", state Hormuzd Katki and Nicolas Wentzensen from the National Cancer Institute, Bethesda, USA, in an accompanying Comment.

It is well established that HPV testing is more sensitive than cytology at detecting precancerous high-grade cervical lesions, but whether HPV testing offers better protection in two screening rounds over a long screening interval (5 years) has not been investigated.

The POBASCAM trial, led by Chris Meijer and colleagues from the VU University Medical Centre, Amsterdam, the Netherlands, studied nearly 45,000 women aged 29 to 56 years attending routine cervical screening in the Netherlands.

The investigators examined whether HPV testing resulted in fewer high-grade cervical lesions and cervical cancer in the second round of screening because of earlier detection and treatment of lesions, and assessed the most appropriate age for starting HPV testing.

At the start of the study, women were randomly assigned to receive either HPV DNA testing and cytology or cytology alone. At the second screening round 5 years later, HPV and cytology testing were done on all women.

In the first screen, HPV testing identified significantly more cancer precursors (cervical intraepithelial neoplasia grade 2 or worse [CIN2+]) than cytology alone.

Five years later, significantly fewer women had CIN grade 3 or worse (CIN3+) lesions and cervical cancer in the HPV group compared with women given cytology alone.

"Implementation of HPV DNA testing in cervical screening leads to earlier detection of clinically relevant CIN grade 2 or worse, which when adequately treated, improves protection against CIN grade 3 or worse and cervical cancer", explain the authors.

The improved protection against CIN3+ in the HPV group was largely due to the early detection of high-grade cervical lesions caused by HPV16 (one of the key cancer-causing HPV types), indicating that HPV testing could eventually reduce cancer-related illness and death.

Importantly, when both screening rounds were combined, the cumulative detection of CIN2+ and CIN3+ did not differ between women aged 29󈞍 years and women older than 33 years, indicating that HPV testing did not lead to over-diagnosis of regressive CIN2+ lesions in younger women.

The authors say: "Our results...lend support to the implementation of HPV DNA testing in programmed cervical screening starting at age 30 years."

"The POBASCAM trial shows that 5 year screening intervals are safe, and that conservative management of HPV-positive women can control excess CIN grade 2 or 3 while preventing cervical cancer. However, how the POBASCAM protocol would perform in other populations that have different baseline cancer rates, compliance, and management infrastructure, is unclear", add the Comment authors.
Professor Chris Meijer, VU University Medical Centre, Amsterdam, The Netherlands Via Ms Caroline Arps, VU University Medical Centre Communication Office. T) +31 20 444 3444 E) cjlm.meijer@vumc.nl

Dr Hormuzd A Katki, National Cancer Institute, Bethesda, USA. Via NCI Press Office T) +1 301 496 6641 E) Ncipressofficers@mail.NIH.gov


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