HPV testing supported as sole primary screening test for cervical cancer

[unseennude]

An analysis of data for more than 60,000 women in North America and Europe suggests that HPV testing should be the sole primary screening test for cervical cancer, with cytology reserved for HPV-positive cases.

Findings from individual studies have suggested that for primary screening, HPV testing is more sensitive than cytology. However, firm conclusions could not be reached, due in part to differences in methodology between the studies.

In the current study, Dr. Jack Cuzick, from the Queen Mary School of Medicine in London, and colleagues analyzed data from all European and North American studies that included routine cytology and additional HPV testing as a parallel test.

The findings appear in the April 3rd online issue of the International Journal of Cancer.

HPV testing was 96.1% sensitive in detecting cervical intraepithelial neoplasia (CIN) 2+, compared with just 53.0% for cytology. By contrast, HPV testing had a lower specificity: 90.7% vs. 96.3% for cytology.

The authors also found that the sensitivity of HPV testing remained stable regardless of geographic region, whereas high variability was seen with cytology. Similarly, the sensitivity of HPV testing remained high regardless of patient age, whereas cytology performed much better in women over 50 years than in younger women.

As patient age increased, the specificity of both tests rose, the report indicates.

"While well-conducted screening programs based on cytology have undoubtedly led to a large reduction of cervical cancer in some countries, the high variability in sensitivity reported here indicates the need for strict quality control," the authors emphasize. "HPV testing is highly reproducible, more easily monitored, provides an objective test outcome and can be easily automated."

Int J Cancer 2006;119.