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HPV Tests Improve Cervical Cancer Risk Prediction
COPENHAGEN -- Testing for the human papilloma virus -- particularly in older women -- can be a valuable tool for predicting future cervical abnormalities and cancer, found researchers here.
COPENHAGEN, Nov. 1 -- Testing for the human papilloma virus -- particularly in older women -- can be a valuable tool for predicting future cervical abnormalities and cancer, found researchers here.
The finding comes from a prospective dual-cohort study in Denmark, in which 7,218 women from the ages of 22 to 32 and 1,305 women ages 40 to 50, were followed for a decade after initial negative Pap smears and testing for human papilloma virus (HPV), according to Susanne Kjaer, M.D., of the Danish Cancer Society.
The majority of women in both groups had both a negative Pap smear and a negative HPV test at the beginning of the study, in 1991, Dr. Kjaer and colleagues reported in the Nov. 1 issue of Cancer Research.
But among those who were positive for HPV - 17% in the younger women and 3.6% in the older women - the risk of later cervical abnormalities, up to and including cancer, was markedly higher than among those who were negative on both tests, Dr. Kjaer and colleagues reported.
Specifically, the researchers found that the 10-year absolute risk of cancer or grade three cervical intraepithelial neoplasia (CIN3) was about 13.6% in the younger women with a baseline positive HPV test, and 21.2% in the older women who were HPV-positive. By contrast, among women who were HPV-negative at baseline, those in the younger cohort had a 10-year absolute risk of 4.1% and those in the older group had a risk of 1.7%.
The risks were probably lower in the younger women even though they had a higher prevalence of HPV infection, she said in a statement, because many such infections were transient, while in older women they were persistent and caused greater changes at the cellular level.
"This shows that the HPV test was better than a Pap smear at predicting worrisome changes in the cervix over time," because Pap smears were negative in all the women in the study, Dr. Kjaer said.
One implication, she said, is that the HPV test should be routinely used in older women, with or without a Pap smear. "Based on these results, we feel that an HPV test would benefit older women, whether or not that test is used in conjunction with Pap smears, or used by itself as an initial screen," Dr. Kjaer said.
In the younger cohort:
- 1,229 women had an initial positive HPV test.
- Of the 5,989 who were negative for HPV, 458 - or 8% -- went on to have abnormal cytology on Pap smear over the 10-year study period.
- Of those who tested positive, 275 - or 22% -- developed atypia.
Among the older women:
- 47 had an initial positive HPV test.
- Of the 1,258 who were negative for HPV, 94 - or 7% -- went on to have abnormal cytology.
- Of those who tested positive, 14 - or 30% -- developed atypia.
