An article this week in the lancet found at that HPV-based cervical cancer screening was better than cytology-based methods (see http://dx.doi.org/10.1016/S0140-6736(13)62028-0). They looked at four randomized trials in Europe, with 176,000 women aged 20-64 assigned to HPV-based screening (in 3 of these studies it was combination cytology plus HPV) versus cytology screening alone. Women were followed on average of 6.5 years to assess the development of invasive cervical carcinoma, with a screening interval of 3 years for those with a negative result. 107 invasive cervical cancers were found. Although there was not any difference in the first 2-1/2 years of followup, thereafter it was found that HPV-based screening provided 60-70% greater protection against invasive cervical carcinoma as compared with cytology. their finding was even more significant in women in the 30-34 age range, an unanticipated result. They felt their data supported HPV screening from age 30 with screening intervals of at least every 5 years.
Results from this study reinforce the decision at our Health Center (as per ACOG and USPSTF) to screen every 5 years for women aged 30 or older with HPV-based screening. However, as recommended, we do the combination of cytology with HPV screening. the study authors do raise the issue “because cotesting leads to many unnecessary colposcopy procedures, stand-alone HPV testing also seems recommendable”. so, maybe we should be doing only HPV testing in women over the age of 30??
this article also raises peripherally the issue of cervical cancer screening in a woman who has never been sexually active, or continued cervical screening on patients who have had negative prior HPV screening and are no longer sexually active (the subtext here is: cervical cancer is basically a sexually transmitted disease caused by certain specific strains of HPV). i personally do not perform cervical cancer screening in women who have never been sexually active (the issue here, though, is to be certain that the woman really has not been sexually active). for women who have had adequate negative screens (eg, normal HPV screens twice in the preceding 10 years), and have not been in a sexual relationship for several years with and a very high probability of not getting into one (as in many of our patients from some different cultural backgrounds), it may be reasonable to me to stop screening. (and, not so surprisingly, when i ask if they would like a vaginal exam, the answer is almost always a resounding “no”). this is not the recommendation of ACOG or USPSTF, but seems to make sense based on the information at hand.
geoff