Smear test 'bettered by HPV test'

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Cervical cancer deaths could be cut if a different screening test was used in the first instance rather than smear tests for over-35s, say researchers.

Testing women for human papillomavirus (HPV), which is strongly linked to the disease, picks up cancers earlier, they told The Lancet Oncology.

Italian data on 95,000 women showed those tested for HPV developed fewer cancers than those who only had smears.

But the authors said this strategy was unsuitable for women younger than 35.

In the under-35s, HPV testing would risk over-treatment because it detects problems that would right themselves spontaneously, say the Italian team.

Fewer cancers

Their study followed the large sample of women in Italy over a period of three and a half years.

We might be able to spot the warning signs even earlier and it might, in future, mean that women go for screening less often. Dr Lesley Walker, director of cancer information at Cancer Research UK

It found that HPV testing was more sensitive than smear tests at picking up pre-cancerous changes to cervical cells.

According to the researchers, the data suggests HPV testing would also needed repeating less often - five-yearly, rather than three-yearly for smears.

Dr Guglielmo Ronco and his team, from the Centre for Cancer Prevention in Turin, say it should be used as the first check in women over 35 and only those who test positive for the virus should go on to have a smear test and any necessary treatment.

Dr Ronco said: "Our data support the use of stand-alone HPV testing as the primary screening test.

"Picking up the cancers earlier would save lives."

An expert in cervical cancer and screening, Professor Henry Kitchener of Manchester University, welcomed the overall findings.

But he urged caution about the excluding younger women.

"I would think very carefully about ruling out HPV testing for women who are under 35," he said.

"The HPV test has positive benefits because it is so sensitive, and there is uncertainty about how many of the problems it detects in younger women would get better by themselves."

The report was also welcomed by Dr Lesley Walker, director of cancer information at Cancer Research UK, which funds one of the study's authors.

She said: "Cervical screening looks for changes in the cells of the cervix before a cancer has developed.

"This research suggests that by testing for HPV in women aged 35 and over we might be able to spot the warning signs even earlier and it might, in future, mean that women go for screening less often. "

Pilots

The NHS began began piloting the use of HPV testing as an "add-on" to smear tests in 2008.

Professor Julietta Patnick, director of the NHS Cancer Screening said: "The NHS Cervical Cancer Screening Programme always takes interest in new studies looking at methods of cervical cancer screening.

"The role of HPV in the development of cervical cancer is well established and we have been exploring the potential use of HPV testing within the cervical screening programme for some time."

Cancer Charities also expressed an interest.

Robert Music, director of cervical cancer charity Jo's Trust, said: "HPV testing will almost certainly have a greater role in the future with the focus on older women because of the high number of transient HPV infections in younger women."

But he warned that testing for the HPV needed to be handled sensitively given that it is a sexually transmitted virus.

"What is also important is for there to be increased education about HPV and HPV testing to avoid future stigma, anxiety and psychosocial damage."