Human papillomavirus (HPV) testing should become the primary screening tool to rule out cervical cancer, claims a new study.
The ATHENA trial recommends testing for the two most dangerous strains of HPV – HPV16 and HPV18 – as it will identify more precancerous lesions than using the current screening technology of cytology.
The study, publishing in The Lancet Oncology, states that cytology should be reserved for women who test positive for HPV, deciding which women need immediate colposcopy.
HPV testing would be an efficient option and reduce manpower requirements in laboratories, providing “potentially cost-effective and safe cervical cancer screening”, commented the authors of the study.
Guglielmo Ronco and colleagues from the Centre of Cancer Prevention in Turin, Italy said: “The results also provide useful information about triage strategies for parts of the world where high-quality cytology has been difficult to implement and combinations of HPV tests might eventually offer a more sustainable option.”
The ATHENA study aimed to evaluate the performance of HPV testing compared with liquid-based cytology, and to formulate more effective treatment ideas for HPV patients.
The trial involved more than 47,000 American women over the age of 25, who attended regular cervical screenings within a 15-month period.
HPV tests detected a considerably larger amount of existing high-grade precancers in 92% of women who had colposcopy compared to 53.3 % who were given cytology.
The study also found that a combination of HPV with cytology was of little benefit compared with HPV testing alone. The combination method improved accuracy by only 4.7%, but increased the number of screen positives by more than a third.
HPV16 and HPV18 currently account for 70% of invasive cervical cancer cases, with approximately 27% of women being infected with HPV in the US. Treatment management for HPV patients remains unclear, but HPV DNA testing is widely known to be more effective than cytology-based screening.