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February 2019

Study supports extending cervical screening intervals


HPV screening is practical on a large scale and more sensitive than smear testing, say researchers


Screening for high risk human papillomavirus (HR-HPV) infection works well in practice and is more sensitive than cytology (smear) testing – offering greater protection against cervical cancer, confirm researchers in The BMJ.

Their findings therefore support a switch to HPV screening across England and provide reassurance that screening intervals could be safely extended to at least five years, without increasing the risk of potentially life-threatening disease.

At present, 2,500 cases of cervical cancer are diagnosed each year in England, with a quarter diagnosed after a ‘normal’ smear test result.

Clinical trials show that HR-HPV screening leads to earlier detection of cervical lesions (known as cervical intraepithelial neoplasia or CIN) than liquid-based cytology or LBC (“smear”) testing.

As such, NHS England and Public Health England are working towards a national roll-out of HPV screening by the end of 2019.

To ensure these trial results would work in the ‘real world’ a large pilot study of routine HPV and LBC testing was carried out in six NHS laboratories across England.

A team of UK researchers analysed results from this pilot, which included 578,547 women aged 24-64 years undergoing routine cervical screening (32% HR-HPV; 68% LBC) between May 2013 and December 2014, who were followed up until May 2017.

Women were immediately referred for further testing (colposcopy) if their HR-HPV test was positive and cervical lesions were found.

HR-HPV positive women with no cervical lesions were asked to return in 12 months for another test (early recall), and if HR-HPV persisted without abnormal cells, were recalled again at 24 months. Reassuringly, 80% of women attended these early recall appointments.

After taking account of factors that might have affected the results, the researchers compared levels of cervical lesions (CIN) picked up by the two screening tests.

They found that HR-HPV screening detected substantially more CIN than LBC testing and this increased detection in prevalence (existing cases) was followed by a marked reduction in incidence (new cases) after three years, ‘lending strong support to an extension of the screening intervals,’ the authors conclude.

Rebolj M, et al. BMJ 2019;364:l240