Two HPV tests better than one for cervical screening

British Journal of Cancer

Doing the human papillomavirus (HPV) test twice with a short interval between tests would reduce the number of women having unnecessary treatment, new research shows.

The Swedish study also suggested that the opportunity to do a HPV test at home could increase the number of women screened for cervical cancer who otherwise do not respond to screening invitations.

The research1, published today in the British Journal of Cancer2, looked at around 2800 women who took a self-sample HPV test at home.

Those with a positive result were invited for a repeat HPV test at a clinic, between one and three months after the first test.

This was to see if there was a persistent HPV infection, which is more likely to lead to changes in the cells of the cervix.3

If the second test was also positive it was more likely that there were abnormal cell changes on the cervical lining which could become cancerous – treating these changes can prevent cervical cancer from developing.

While most women infected with HPV do not develop cervical cancer, the virus is a major cause of the disease.

The researchers suggest testing for HPV twice means that fewer women would be called for further investigations unnecessarily.

The results showed that out of the 188 women who tested positive in the first HPV test, only 44 women (23 per cent) actually had moderate cervical changes or worse on further examination.

When the 188 women were tested a second time, 88 still had an HPV infection and 36 of these women (41 per cent) had moderate cervical changes or worse.

Professor Ulf Gyllensten, lead author of the study based at the Uppsala University Hospital in Sweden, said:

“This study confirms previous evidence that repeating the HPV test reduces the number of women who are sent for other more invasive tests – when in fact they do not have any serious cervical changes on further examination.

“This still works if women are able to do the first test at home, which can help overcome some of the emotional and physical barriers to cervical screening.”

Since April the HPV test has started being rolled out as part of the existing NHS cervical screening programme in the UK.

Those with mild or borderline changes from the current screening test (liquid-based cytology, often called the smear test) will get an HPV test. They will only undergo further procedures if the test is positive.

Women who have mild or borderline cell changes but do not have an HPV infection are very unlikely to develop cervical cancer so can safely continue with normal screening. Women with these cell changes and an HPV infection may need further investigation or treatment.

Sara Hiom, director of health information at Cancer Research UK, said:

“This study provides valuable additional data which can help inform improvements in the cervical screening programme in future – especially when screening will be increasingly taken up by women who have been vaccinated against HPV.

“It’s important that we reduce the number of women going through unnecessary procedures so that we can minimise any associated anxiety, and also make colposcopy services and screening more efficient.

“Cervical screening is a great way of preventing cervical cancer from developing in the first place, by diagnosing and treating changes in the cells that could become cancer if left alone. It saves thousands of lives in the UK every year, so Cancer Research UK encourages women to take up screening when invited.”

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References

1. Gyllensten U et al., Short-time repeat high-risk HPV testing by self-sampling for screening of cervical cancer, British Journal of Cancer (2011)

Notes to Editor

2. funded by the County Council of Uppsala, the Medical Faculty of Uppsala and the Swedish Cancer Foundation.

3 Up to 8 out of 10 people in the UK will be infected with the HPV virus at some point in their lives. HPV infections are usually on the fingers, hands, mouth and genitals.
For most people, the infection will get better on its own and they will never know they had it. But in some people the infection will stay around for a long time and become persistent. Persistent infections are more likely to lead to cervical changes and cervical cancer.

NHS Cervical Screening Programme

At present, women are screened for cervical cancer using a technique called liquid-based cytology. Cervical cells are collected and analysed for suspicious changes which could be the pre-cursors of cervical cancer. Women who are found to have serious cell changes on this test are referred for a more detailed examination of the cervix known as colposcopy followed by treatment if necessary. This process will remain unchanged.

Under the current system women with borderline changes are offered repeated tests with liquid-based cytology. Those with persistent borderline results are offered colposcopy.

When the HPV test is rolled out, only those women with borderline changes who also test positive for HPV will be referred for this detailed examination. Women who do not have an HPV infection will be returned to the routine screening process.