From the Journals

Real-world data support extended cervical cancer screening interval

Publish date: November 29, 2017

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Findings could impact HPV-positive triage

The study by Castle et al provides important insight into the effects of repeated testing of HPV, cervical cytology, and testing both together. The authors are to be commended for performing their analysis, which involved almost 1 million women.

There are several important observations that can be made. One is that the risk of detecting cancer is decreased after cotesting HPV and cervical cytology both show a negative result, and that this risk is further reduced after the second and third negative HPV/cytology test. This could mean less frequent screening could be safely adopted in women who are HPV and cytology negative, which would lead to fewer women referred for unnecessary colposcopy and treatment, reducing their stress and discomfort.

These data could alter how women are triaged on the basis of the HPV test. In HPV-positive women, for example, current practices are appropriate for the first and perhaps second round of HPV testing, but perhaps subsequent rounds could become less stringent. Conversely, when there is an HPV-negative result, even in the presence of a positive or equivocal cytology, screening intervals may still be safe to lengthen as there is only a small increase in risk versus being both HPV and cytology negative.

Guglielmo Ronco, MD, PhD, is formerly of the City of Health and Science University Hospital of Turin (Italy). Silvia Franceschi, MD, PhD, is with the International Agency for Research on Cancer in Lyon, France. They reported having no relevant financial disclosures. Their comments were adapted from an accompanying editorial (Ann Intern Med. 2017. doi: 10.7326/M17-2872).

FROM ANNALS OF INTERNAL MEDICINE

A cervical cancer screening interval of 5 years or longer may be safe for women with one or more negative cotests using the high-risk human papillomavirus (HPV) test and cervical cytology, according to the results of a large observational study.

The findings also suggest that one or two negative HPV tests, regardless of cytology, may be enough to extend the screening interval, the researchers noted.

^{Courtesy Wikimedia Commons/John Hayman/Creative Commons License}

The risk of invasive cervical cancer, cervical intraepithelial neoplasia (CIN) grade 3, and adenocarcinoma in situ decreased with each round of cotesting performed, with a greater absolute decrease in risk seen between the first and second round of testing than between the second and third round, Philip E. Castle, PhD, of Albert Einstein College of Medicine, N.Y., and his colleagues reported (Ann Intern Med. 2017. doi: 10.7326/M17-1609).

The 5-year risk decreased with each successive HPV-negative and cytology-negative result, falling from 0.098% in the first cotesting round, to 0.052% in the second round, and 0.035% in the third round. The 5-year risks were similar with an HPV-negative cotest result, regardless of the outcome of cytology: 0.114%, 0.061%, and 0.041%.

The results are based on data from more than 990,000 women in the Kaiser Permanente Northern California health care system who had one or more cotests from 2003 to 2014.

These findings come as the U.S. Preventive Services Task Force (USPSTF) has issued draft recommendations that would call for either HPV testing alone every 5 years starting at age 30 years or cytology every 3 years, but no cotesting. The American College of Obstetricians and Gynecologists currently recommends cotesting with cytology and HPV testing every 5 years or cytology alone every 3 years in women aged 30-65 years (Obstet Gynecol. 2016;128[4]:e111-30).

The study was partially funded by the National Cancer Institute. Some of the researchers are employees of the National Cancer Institute. The researchers reported receiving cervical screening tests and diagnostics at reduced or no cost from Roche, BD Biosciences, Cepheid, Arbor Vita, and Hologic.

Real-world data support extended cervical cancer screening interval

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