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Adding cytology to HPV testing slightly improves cancer and precancer detection
Clinical Question
What are the contributions of the cytology and human papillomavirus components of co-testing in the detection of cervical precancer and cancer?
Bottom line
Human papillomavirus (HPV) testing alone will detect most cases of cervical cancer and precancer. Adding cytology will detect 6% and 4% more cases, respectively. 2b
Reference
Study design: Cohort (prospective)
Funding: Government
Setting: Outpatient (primary care)
Synopsis
These authors identified a cohort of 1.2 million women, 30 years and older, who were screened every 3 years for cervical cancer at Kaiser Permanente of Northern California. After 10 years of follow-up, the authors identified 623 women with cervical cancer and 5369 women with precancers (cervical intraepithelial neoplasia grade 3 or adenocarcinoma in situ) from the original cohort who underwent co-testing (cytology plus HPV) every 3 years. Among women with cervical cancer, 77% had a positive HPV test result compared with 59% who had abnormal cytology. Only 6% of women with cancer had a negative HPV test and abnormal cytology. Among women with precancers, 84% had a positive HPV test and 62% had abnormal cytology. Only 4% of women with precancers had a negative HPV test and abnormal cytology. Unfortunately, testing still misses 17% of women with cancer and 13% of women with precancer. The good news is that two-thirds of the cancers were found by the first co-test. A 2016 study reported that the cost of cytology was approximately $30 and HPV testing was approximately $44 (www.ncbi.nlm.nih.gov/pmc/articles/PMC4900245/).
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
good poem
Would be good to mention the HPV false positive raté to put results in perspective
would be great to have the full results re. clinical outcome of the treatments following screening.
Trust the authors will publish their date soon
HPV serology not readily available in NS yet
I have been recommending both cytology and HPV testing to those patients who have had multiple partners. In BC, patients have to pay for the HPV test which costs about $100.00; therefore, not many of them go for the test.
It proves that even with dual testing, cervical screening every 3 years is not enough. There are many sources of error and screening every 1-2 years makes it much lass likely that cancers will be missed for a three year time period. Especially terrible since theses women are mostly in the child bearing age group.
This indicates to me that co-testing is well worthwhile. The two tests added together are still relatively inexpensive as they increase the sensitivity and specificity of the results. Cervical cancer should no longer be an issue these days.