HPV testing more sensitive than conventional screen
Many stent patients delay taking clopidogrel with adverse results
Testing for human papillomavirus (HPV) DNA was a more sensitive means of detecting cervical cancer and pre-cancerous lesions than conventional Pap testing, a Finnish screening program found.
The population-based program invited more than 50,000 women between 30 and 60 to be screened and then randomized them to conventional testing or HPV testing. The outcomes were cervical cancer and a composite of cervical intraepithelial neoplasia grade III and adenocarcinoma in situ (referred to as CIN III+). The study was published online by BMJ last week.
The women who got the HPV tests had an increased rate of diagnosis with CIN III+ (77% higher than women screened conventionally). The differences in cervical cancer between the groups were not statistically significant (6 in the HPV group vs. 8 in the conventional group if all women invited to screening were included, 6 vs. 3 among those who attended the screening).
Of the women who were referred for additional screening after an HPV test, 794 had a negative result on cytology triage (of whom 11 were subsequently found to have CIN III+), 353 women had at least a borderline result on cytological triage (15 eventually diagnosed with CIN III+) and four women remained with an inadequate screening result because of inadequate cytological triage.
The study authors concluded that HPV testing compared well with conventional testing and didn't cause too much burden to patients, at least in women age 35 or older. They noted that the high rate of positive HPV tests among women under 35 makes HPV screening challenging and indicates the need for better triage tests. They recommended that primary HPV screening be piloted in additional programs, in Finland as well as elsewhere in the world.