High-risk human papillomavirus test a good option for cervical cancer screening.

Abstract

Papanicolaou tests have long been recognized as highly effective in detecting both precancerous and cancerous cells in cervical cancer, but researchers have recently demonstrated that testing for high-risk viral types of human papillomavirus (HPV) also is an excellent screening tool for the disease. The study, led by researchers from University of California, Davis, and Kaiser Permanente Northwest, offers a comprehensive analysis of 8 clinical trials and 4 cohort studies.1 The findings were used to inform the US Preventive Services Task Force’s updated cervical cancer screening guidelines, which were published in the same issue.2 Although most HPV infections resolve on their own, those that do not can lead to cervical cancer, 90% of which is caused by the virus. For that reason, screening programs are essential in reducing both incidence and mortality rates of the disease, experts say. In the study, which was led by Joy Melnikow, MD, MPH, director of the UC Davis Center for Healthcare Policy and Research in Sacramento, California, researchers assessed studies of either high-risk HPV tests alone or cotesting. They discovered that high-risk HPV testing found a consistently higher rate of precancerous cells and cancer in comparison with cytology. At the same time, however, the former produced higher rates of false-positives and more follow-up testing than the latter. Investigators also assessed the benefits and harms of high-risk HPV testing. Benefits included detecting invasive cervical precancer, whereas harms were the higher rate of false-positive test results, higher rates of unnecessary colposcopies, and any psychological effects resulting from false-positive results. The analysis concluded that high-risk HPV testing alone resulted in a statistically significant increased detection rate of cervical intraepithelial neoplasia in comparison with cytology. Cotesting studies, meanwhile, showed no statistical increase in cervical intraepithelial neoplasia detection. All study participants were part of organized screening programs that invited them to be screened at regular intervals. One of the biggest challenges in reducing cervical cancer rates nationwide, Dr. Melnikow notes, is getting more women to participate in such organized screening programs.