A new strategy could replace conventional smear tests as the initial screening test for cervical cancer in young women, say researchers in the July issue of The Lancet Oncology.
The New Technologies for Cervical Cancer group did a randomised controlled trial of more than 11 000 women aged 25–34 years. About half the women received conventional smear tests, and the other half were tested with a DNA test for human papillomavirus (HPV), which is a cause of cervical cancer, together with a test called liquid-based cytology. Using a variety of different referral criteria, the researchers were able to identify a strategy that could detect more high-grade precancerous lesions than the conventional smears, with only a slight increase in the number of women diagnosed incorrectly as having cancer. This approach means that more women could be treated earlier, offering them a better chance of cure.
"HPV testing alone with cytology as a backup, seems to be the most reasonable way of using HPV testing as [the] primary screening test", comments Dr Ronco, who adds: "Follow-up will provide data on possible overdiagnosis and on the feasibility of extended intervals. They will be crucial for the decision of switching to HPV testing in routine practice for cervical screening."
In an accompanying commentary, Eduardo Franco, McGill University, Canada, notes that the preliminary analysis is unique because it focuses on young women aged 25–34 years, in whom the benefits of HPV testing are less clear because of the high prevalence of HPV infections and the consequently high number of referrals to colposcopy if HPV testing is to guide diagnostic work-up. He adds that "HPV testing with cytological triage is a theoretically logical policy [for vaccinated women] that protects the effectiveness of cytological testing by allowing it to be done where prevalence of lesions is artificially high, as is the case when reading smears from HPV-positive women".
Contact: Dr Guglielmo Ronco, Centre for Cancer Prevention, Turin, Italy. T) +390116333850) firstname.lastname@example.org or Dr Eduardo Franco, Department of Oncology and Epidemiology, McGill University, Montreal, Canada. T) +1 514 398 6032 email@example.com
Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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