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HPV testing better than cytology for women vaccinated against HPV
Clinical Question
What is the best means of cervical cancer screening in women who have received the human papillomavirus vaccination?
Bottom line
In women who had previously been offered the human papillomavirus (HPV) vaccine, screening for HPV every 5 years, with cytology and colposcopy follow-up as needed, resulted in higher rates of identification of high-grade precancerous disease (CIN2+) than standard liquid-based cytology every 2.5 years with HPV follow-up co-testing as needed. 1b
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Foundation
Setting: Outpatient (any)
Synopsis
In Australia, where this study was performed, all women included in this aspect of the study had been offered HPV vaccination, either at age 12 or 13 years or later as a catch-up, with an estimated 50% to 77% of women receiving all 3 doses. In this study 1078 women younger than 33 years who had been offered HPV vaccine were randomized, using concealed allocation, to cervical cancer screening using 1 of 3 strategies: (1) liquid-based cytology (ThinPrep) every 2.5 years with follow-up HPV co-testing if the results were abnormal; (2) HPV testing every 5 years with follow-up cytology or colposcopy if the results were abnormal; or (3) HPV testing every 5 years with follow-up cell staining for oncogenic markers in women with identified oncogenic HPV (HPV 16 or 18) on initial screen (further details of follow-up testing and confirmation can be found here: https://goo.gl/J3MX4V). Rates of identification of high-grade precancerous disease (CIN2+) were higher in women in each HPV testing arm (2.6% and 2.9%) than with cytology (0.5%; P = .05). Unfortunately, the researchers don't know the percentage of eligible women who received the vaccine, and most of the women had been screened at some point before the study was started, biasing the sample toward lower rates of disease.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Screening by blood testing would certainly be easier to do and more acceptable to many women. This could be a major step forward in early treatment of this potentially devastating disease.
The synopsis doesn’t go to the key implication of this study. It shows a clear balance of the harms of routine cytologies of all the women, including under diagnosis, beyond initial cytologies, versus cytologiy/ colposcopy of women targeted by hpv test outcomes, given that cytologies and colonoscopies are both included as ‘harms.’ In short, improved outcomes, limited interventions. Thanks for posting this review
So far in bc we aren’t even doing liquid based cytology let alone HPV testing so this is a long way from the real world in canada I think!!
I wonder how the results would differ depending on the prevalence of vaccination against HPV in regions
good poem