Women who receive human papillomavirus (HPV) testing, in addition to a pap smear, receive a faster, more complete diagnosis of possible cervical pre-cancer, according to UK researchers.
Their study, published in JAMA Oncology, is the first comprehensive evaluation of HPV testing on the long-term outcomes of women who had received a borderline abnormal pap test result.
“Knowing a woman’s HPV status can help determine her likelihood of needing additional procedures”
A total of 457,317 women were included in the study by the Queen Mary University of London and the University of New Mexico Comprehensive Cancer Center.
Of these, 4.5% received a borderline abnormal result through a pap smear and were followed for five years. Some of the women with borderline abnormal pap smear results had an HPV test.
HPV testing led to a 15.8% overall increase in the detection of cervical pre-cancers and time to detection was much shorter – a median of 103 days versus 393 days.
Virtually all cervical pre-cancers were detected in women who tested positive for HPV, said the researchers, suggesting HPV testing to be a good additional screening method after the pap smear.
The researchers highlighted that colposcopy could then be focused on women who would need it most – those with a positive HPV test.
At the same time, however, HPV testing of women resulted in 56% more biopsies and a 20% increase in surgical treatment procedures performed. Most of the additional biopsies were for low grade lesions which could have regressed, indicating some overtreatment due to HPV testing.
Professor Jack Cuzick
Professor Jack Cuzick, from Queen Mary University, said: “This study shows that knowing a woman’s HPV status can help determine her likelihood of needing additional procedures, and prioritise immediate treatment and medical resources to the women who need them most.”
Professor Cosette Wheeler, from the US arm of the study, added: “The benefits of HPV testing outweigh the harms observed but it’s important to understand and quantify the harms as well.”
The study authors warned that, as it was an observational study, it was possible there could be socioeconomic or other relevant differences among healthcare facilities that were not measured but that could have affected the findings.