HPV test, then Pap test, then repeat HPV test may improve cervical cancer detection

NEW YORK (Reuters Health) - For cervical cancer screening, human papillomavirus (HPV) DNA testing, followed by triage with a standard Pap test and repeat HPV testing of cytology-negative women is a feasible strategy that may increase the accuracy of cervical cancer screening, according to a study in the January 13 online issue of the Journal of the National Cancer Institute.

Compared to cytology alone, this screening strategy improved detection of precancerous lesions without a substantial increase in the number of false-positive test results, Dr. Joakim Dillner of Lund University in Malm�, Sweden, and colleagues found.

Randomized trials have shown that using HPV DNA testing in cervical cancer screening programs would increase detection of cervical intraepithelial neoplasia, the precursor to cervical cancer, compared with cytology. However, HPV DNA testing also leads to an increase in false-positive tests, which lead to unnecessary and costly retesting.

In the current study, Dr. Dillner and associates compared the efficacy of 11 different screening strategies that used HPV DNA testing, cytology, or a combination of the two. They retrospectively analyzed data from 6257 women, aged 32 to 38 years, who were enrolled in the intervention arm of a large randomized screening trial called Swedescreen in which HPV DNA testing was used in addition to standard cytology.

Mirroring the results of previous trials, the use of HPV DNA testing in conjunction with cytology resulted in a 35% increase in sensitivity to detect grade 3 neoplasia or worse, compared with cytology alone, "without a statistically significant reduction in the positive predictive value (relative PPV = 0.76).

This strategy, however, more than doubled the number of screening tests required.

By contrast, primary screening with HPV DNA testing, followed by cytological triage and repeat HPV DNA testing of women with normal cytology who are HPV DNA positive after at least 1 year resulted in a 30% higher detection rate, compared to cytology alone, with only a 12% increase in the number of screening tests required.

This strategy "appears to be the most feasible for cervical cancer screening," Dr. Dillner and colleagues conclude.

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