HPV Test Identifies a Majority of Women with High-Grade CIN
An analysis of several previously published studies concludes that a test for high-risk types of human papillomavirus (HPV) identifies a large majority of women with high-grade cervical intraepithelial neoplasia (CIN). These results were published in the International Journal of Cancer.
Effective screening programs for cervical cancer have decreased the frequency of cervical cancer in the U.S. Screening can detect precancerous changes to the cervix, known as cervical intraepithelial neoplasia (CIN). The severity of CIN is classified on a scale of 1 to 3, with 3 being the most severe. Because the more severe types of CIN may progress to cervical cancer, removal of these lesions reduces the risk of cancer.
Cervical cancer screening has traditionally relied on the Pap test. During a Pap test, a sample of cells is removed from the cervix using a small wooden spatula or a brush. The cells are examined by a laboratory and results are then classified into five categories: normal; atypical squamous cells of undetermined significance (ASCUS); low-grade squamous intraepithelial lesions (LSIL); high-grade squamous intraepithelial lesions (HSIL); or cancer.
More recently, researchers have evaluated the role of HPV testing in cervical cancer screening. HPV is a sexually transmitted infection that is the primary cause of cervical cancer. Different types of HPV are classified as “low-risk” or “high-risk” based on how likely they are to cause cervical cancer. Screening women for high-risk types of HPV may identify women who are most likely to have precancerous changes to the cervix.
To compare the Pap test and the HPV test as cervical cancer screening tools, researchers assessed the results of several previously published studies. The studies were conducted in North American and Europe and enrolled more than 60,000 women.
The HPV test identified a higher proportion of the women with high-grade CIN (CIN 2 or CIN 3) than the Pap test. HPV testing identified 96% of these women and the Pap test identified 53%.
The ability of the HPV test to identify women with high-grade CIN did not vary by age. The ability of the Pap test to identify women with high-grade CIN was greatest in women over the age of 50.
The HPV test was less accurate than the Pap test at correctly classifying women without high-grade CIN. Among women without high-grade CIN, the HPV test correctly classified 91% of the women and the Pap test correctly classified 96% of the women.
Among women with a positive HPV test, 16% were found to have high-grade CIN. Among women with a positive Pap test, 20% were found to have high-grade CIN.
Although questions remain about the most appropriate use of HPV testing, the researchers suggest that a strategy of initial HPV testing, followed by a Pap test for those with positive HPV results, may improve the accuracy of cervical cancer screening.
Reference: Cuzick J, Clavel C, Petry K-U et al. Overview of the European and North American Studies on HPV Testing in Primary Cervical Cancer Screening. International Journal of Cancer. Early online publication April 3, 2006.
Effective screening programs for cervical cancer have decreased the frequency of cervical cancer in the U.S. Screening can detect precancerous changes to the cervix, known as cervical intraepithelial neoplasia (CIN). The severity of CIN is classified on a scale of 1 to 3, with 3 being the most severe. Because the more severe types of CIN may progress to cervical cancer, removal of these lesions reduces the risk of cancer.
Cervical cancer screening has traditionally relied on the Pap test. During a Pap test, a sample of cells is removed from the cervix using a small wooden spatula or a brush. The cells are examined by a laboratory and results are then classified into five categories: normal; atypical squamous cells of undetermined significance (ASCUS); low-grade squamous intraepithelial lesions (LSIL); high-grade squamous intraepithelial lesions (HSIL); or cancer.
More recently, researchers have evaluated the role of HPV testing in cervical cancer screening. HPV is a sexually transmitted infection that is the primary cause of cervical cancer. Different types of HPV are classified as “low-risk” or “high-risk” based on how likely they are to cause cervical cancer. Screening women for high-risk types of HPV may identify women who are most likely to have precancerous changes to the cervix.
To compare the Pap test and the HPV test as cervical cancer screening tools, researchers assessed the results of several previously published studies. The studies were conducted in North American and Europe and enrolled more than 60,000 women.
The HPV test identified a higher proportion of the women with high-grade CIN (CIN 2 or CIN 3) than the Pap test. HPV testing identified 96% of these women and the Pap test identified 53%.
The ability of the HPV test to identify women with high-grade CIN did not vary by age. The ability of the Pap test to identify women with high-grade CIN was greatest in women over the age of 50.
The HPV test was less accurate than the Pap test at correctly classifying women without high-grade CIN. Among women without high-grade CIN, the HPV test correctly classified 91% of the women and the Pap test correctly classified 96% of the women.
Among women with a positive HPV test, 16% were found to have high-grade CIN. Among women with a positive Pap test, 20% were found to have high-grade CIN.
Although questions remain about the most appropriate use of HPV testing, the researchers suggest that a strategy of initial HPV testing, followed by a Pap test for those with positive HPV results, may improve the accuracy of cervical cancer screening.
Reference: Cuzick J, Clavel C, Petry K-U et al. Overview of the European and North American Studies on HPV Testing in Primary Cervical Cancer Screening. International Journal of Cancer. Early online publication April 3, 2006.
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