Testing women for the human papillomavirus (HPV) first, instead of using the traditional cervical screening test to detect abnormal cells in the cervix, could prevent around 600 cases of cervical cancer a year in England.
These results – from Cancer Research UK – are being presented at Public Health England’s National Cancer Intelligence Network annual conference in Brighton and published in the Journal of Medical Screening.
Cancer Research UK scientists, based at Queen Mary, University of London, identified more than 8,750 women with cervical cancer and looked back at their screening records. They found almost 40 per cent had a negative cytology test result – the existing cervical screening test – within six years of their diagnosis.
They then used these data to predict how many more cases of cervical cancer could have been prevented if HPV testing had been used as primary screening test instead of the cytology test.
Assuming that primary HPV1 testing would pick up 95 per cent2 of the cases missed by cytology, the researchers estimate that it could prevent up to 33 per cent of cervical cancer cases in women aged 25-64 if introduced in England.
The cervical screening programme prevents cases of cervical cancer by detecting and treating abnormal changes in the cells of the cervix, which can be the precursors of cancer.
At the moment cervical cells are studied under a microscope to detect abnormalities – this is known as cytology. HPV testing is only used when women’s cells display mild or borderline abnormalities.
Primary HPV testing is done in the same way but is better at identifying women at risk of cervical cancer.
In England around 1800 cases of cervical cancer are diagnosed each year in women aged 25-64. This research suggests say that HPV testing could cut that number by around a third predicting that around an additional 600 women might have their cancer prevented.3
Professor Peter Sasieni, study author and Cancer Research UK funded scientist at Queen Mary, University of London, said: “Cervical cancer screening is already hugely effective but our study shows how much better it could be by swapping to primary HPV testing. Not only would introducing primary HPV testing prevent more cases of cancer, it would also mean women who tested negative wouldn’t need to be checked as often.”
Hazel Nunn, health information manager at Cancer Research UK, said: “Although we already have a very effective cervical cancer screening programme, this study suggests that we could do even better if primary HPV testing was introduced here in the UK.
“The National Screening Programme is already piloting the primary HPV test in some parts of England and this should give us a clearer indication of what such a major change to the screening programme would entail. Cervical cancer screening is very effective at catching abnormal cells before they develop into cervical cancer.”
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Castanon, A., Landy, R., & Sasieni, P. (2013). How much could primary human papillomavirus testing reduce cervical cancer incidence and morbidity? Journal of Medical Screening DOI: 10.1177/0969141313492313
1Cervical cancer is linked to persistent infection with some types of the human papillomavirus (HPV). This is a very common, often symptomless virus, which can cause abnormalities in the cells of the cervix. For most women, the abnormalities go away naturally without any need for treatment. However, in a small number of women the HPV infection persists. In these cases, if they are not caught and treated, these abnormalities may eventually develop into cancer.
2Based on the assumption that HPV testing is 95 per sensitive for cancers that would develop over the next 6 years but were missed by cytology, and that 4.3 per cent of those diagnosed by cytology would be missed by HPV testing.
3Although the paper refers to cervical screening in England, the same calculation can be applied to the UK. Applying the same proportion to the 2236 in women aged 25-64 in 2010, suggests introducing primary HPV testing could prevent up to 729 cases of cervical cancer in the UK.