Women who receive human papillomavirus (HPV) testing, in addition to a pap smear, receive a faster, more complete diagnosis of possible cervical precancer, according to a study of over 450,000 women by Queen Mary University of London (QMUL) and the University of New Mexico (UNM) Comprehensive Cancer Center.
HPV is a virus that can cause cervical, vaginal, penile and anal cancers. More than 520,000 cases of cervical cancer are diagnosed worldwide each year, causing around 266,000 deaths. A common screening procedure for cervical cancer is the Pap smear, which tests for the presence of precancerous or cancerous cells on the cervix.
The study, published in JAMA Oncology, used data from the New Mexico HPV Pap Registry in the United States. It is the first comprehensive evaluation of HPV testing on the long-term outcomes of women who had received a borderline abnormal Pap test result.
A total of 457,317 women were included in the study. Of these, 20,677 women (4.5 percent) received a borderline abnormal result through a Pap smear and were followed in the study for five years. Some of the women with borderline abnormal Pap smear results had an HPV test.
HPV testing led to a 15.8 percent overall increase in the detection of cervical precancers 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, suggesting HPV testing to be a good additional screening method after the Pap smear. Colposcopy, which is a medical examination of the cervix, 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 percent more biopsies and a 20 percent 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 from QMUL 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 UNM Comprehensive Cancer Center said: “The benefits of HPV testing outweigh the harms observed but it’s important to understand and quantify the harms as well.”
The authors warn that, as this was an observational study, the use of HPV testing was not randomised. So, it is also possible that there could be socioeconomic or other relevant differences among health care facilities that have not been measured.
“Benefits and Harms of Human Papillomavirus Testing Among Women With Cytology Showing Atypical Squamous Cells of Undetermined Significance” was published in the June 22 online edition of JAMA Oncology (http://jamanetwork.com/journals/jamaoncology). Authors are Jack Cuzick, PhD; Orrin Myers, PhD; Ji-Hyun Lee, DrPH; Yang Shi, PhD; Julia C. Gage, PhD, MPH; William C. Hunt, MA; Michael Robertson, BS; and Cosette M. Wheeler, PhD.
About the UNM Comprehensive Cancer Center
The University of New Mexico Comprehensive Cancer Center is the Official Cancer Center of New Mexico and the only National Cancer Institute-designated Cancer Center in a 500-mile radius. Its 125 board-certified oncology specialty physicians include cancer surgeons in every specialty (abdominal, thoracic, bone and soft tissue, neurosurgery, genitourinary, gynecology, and head and neck cancers), adult and pediatric hematologists/medical oncologists, gynecologic oncologists, and radiation oncologists. They, along with more than 500 other cancer healthcare professionals (nurses, pharmacists, nutritionists, navigators, psychologists and social workers), provided cancer care for nearly 60 percent of the adults and children in New Mexico affected by cancer. They treated 11,249 patients in 84,875 ambulatory clinic visits in addition to in-patient hospitalizations at UNM Hospital. These patients came from every county in the State. More than 12 percent of these patients participated in cancer clinical trials testing new cancer treatments and 35 percent of patients participated in other clinical research studies, including tests of novel cancer prevention strategies and cancer genome sequencing. The 130 cancer research scientists affiliated with the UNMCCC were awarded almost $60 million in federal and private grants and contracts for cancer research projects and published 301 high quality publications. Promoting economic development, they filed more than 30 new patents in FY16, and since 2010, have launched 11 new biotechnology start-up companies. Scientists associated with the UNMCCC Cancer Control & Disparities have conducted more than 60 statewide community-based cancer education, prevention, screening, and behavioral intervention studies involving more than 10,000 New Mexicans. Finally, the physicians, scientists and staff have provided education and training experiences to more than 230 high school, undergraduate, graduate, and postdoctoral fellowship students in cancer research and cancer health care delivery. Learn more at www.cancer.unm.edu.
About Queen Mary University of London
Queen Mary University of London is one of the UK's leading research-focused higher education institutions. With 21,187 students, 4,000 staff and an annual turnover of £400m, we are one of the biggest University of London colleges. We teach and research across a wide range of subjects in the humanities, social sciences, law, medicine and dentistry, and science and engineering. We have been based in a creative and culturally diverse area of east London for over 130 years – our main site in Mile End is one of the largest self-contained residential campuses in the capital. Queen Mary has made a strategic commitment to the highest quality of research. We have invested in this principle by systematically recruiting the best academics in their disciplines from around the world. The results of the most recent national assessment of research – the Research Excellence Framework (REF 2014) – have confirmed our place in the very top group of research-led universities in the UK. Overall we were ranked 9th in the UK among multi-faculty universities and 5th in the UK for the percentage of our 3* and 4* research outputs. Learn more at http://www.qmul.ac.uk/.
Contact Information — United States
Dorothy Hornbeck, JKPR, 505-340-5929, firstname.lastname@example.org
Michele Sequeira, UNM Cancer Center, 505-925-0486, email@example.com
Contact Information — United Kingdom
Joel Winston, Queen Mary University of London, 0207 882 7943, firstname.lastname@example.org