HPV test, compared with Pap, at baseline better predicts CIN3+ at follow-up of 18 years
MONDAY, July 30 (HealthDay News) -- Over 18 years of follow-up, baseline testing showing a negative result for human papillomavirus (HPV) DNA provides greater reassurance against invasive cervical cancer (CIN3+) than baseline normal Papanicolaou (Pap) testing, according to a study published online July 30 in the Journal of Clinical Oncology.
To examine the long-term benefits of clinical HPV DNA testing for cervical precancer and cancer risk prediction, Philip E. Castle, M.D., Ph.D., from the American Society for Clinical Pathology in Washington, D.C., and colleagues collected cervicovaginal lavages from 19,512 women attending a health maintenance program, and retrospectively tested them for HPV. The women underwent prospective follow-up with routine annual Pap testing for up to 18 years.
The researchers found that, over the 18-year follow-up, a baseline negative HPV test provided greater reassurance against CIN3+ than a baseline normal Pap (cumulative incidence rate, 0.90 versus 1.27 percent). Only HPV testing predicted who would develop CIN3+ 10 to 18 years later, while both baseline Pap and HPV tests predicted who would develop CIN3+ within the first two years. Of those with normal Pap, women who were positive for HPV16 and HPV18 had an increased risk of CIN3+ compared to other HPV-positive women with normal Pap. Women with normal Pap who were HPV16- and HPV18-positive had a similar risk as those with low-grade squamous intraepithelial Pap.
"HPV testing to rule out cervical disease followed by Pap testing and possibly combined with the detection of HPV16 and HPV18 among HPV positives to identify those at immediate risk of CIN3+ would be an efficient algorithm for cervical cancer screening, especially in women age 30 years or older," the authors write.
Two authors disclosed financial ties to the pharmaceutical industry.