Study strongly supports the extension of cervical screening intervals

Screening for high-risk human papillomavirus (HR-HPV) infections works well in practice and is more sensitive than cytological (smear) testing – providing better protection against cervical cancer, confirm researchers The bmj aujourd & # 39; hui.

Their results argue for a move to HPV testing in England and rebadure that screening intervals could be safely extended to at least five years, without increasing the risk of a life-threatening disease.

At present, 2,500 cervical cancer cases are diagnosed each year in England, one-quarter after a "normal" smear test result.

Clinical trials show that HR-HPV screening can detect cervical lesions (cervical intraepithelial neoplasia or CIN) earlier than liquid cytology or LBC ("smear") tests.

As such, NHS England and Public Health England are working on a national rollout of HPV testing by the end of 2019.

To ensure that the results of these trials would work in the "real world", a large pilot study on routine HPV and LBC testing was conducted in six NHS laboratories in England.

A team of British researchers badyzed the results of this pilot project, which included 578,547 women aged 24 to 64 years undergoing routine screening for cervical cancer (32% HR-HPV, 68% LBC) between May 2013 and December 2014, followed until May 2017.

Women were immediately referred to another test (colposcopy) if their HR-HPV test was positive and cervical lesions were discovered.

HIV-positive women with HR-HPV who did not have cervical lesions were asked to return within 12 months for another test (early recall) and if HP-HP persisted without abnormal cells, they were recalled at 24 months. Rest badured, 80% of women attended these early reminder appointments.

After taking into account the factors that could affect the results, the researchers compared the levels of cervical lesions (CIN) detected by the two screening tests.

CIN is divided into grades: CIN1, 2+ or 3+. The higher the number, the more the cervix is ​​affected.

They found that HR-HPV screening detected a lot more CIN than LBC (50% more CIN2 +, 40% CIN3 + and 30% cervical cancer).

In addition, a quarter of CIN2 + was detected after early booster in women with no cervical lesions.

The increased sensitivity of HR-HPV screening is also reflected in the remarkably low detection of CIN2 + in HR-HPV negative women when a new screening at 3 years, compared to negative LBC women, he adds.

This is an observational study and researchers can not exclude the possibility that some of their findings are attributable to other unmeasured factors (sources of confusion).

Nevertheless, according to them, this large pilot project carried out under routine screening conditions confirmed that HR-HPV screening is practical on a large scale and confers greater sensitivity for both CIN3 + cancer and cervical cancer. the uterus only for the LBC test.

In addition, this increased detection of prevalence (existing cases) was followed by a marked reduction in the incidence (new cases) after three years, "providing strong support for an extension of screening intervals" they concluded.

Provided by
British Medical Journal