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Negative HPV Screening Test Result Is a Better Predictor of Cervical Cancer Risk Than a Negative Pap Test Result

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Key Points

  • An analysis of more than 1 million woman found that a negative test for human papillomavirus (HPV) infection is a more reliable predictor of the risk of developing cervical cancer than a negative Pap test.
  • The risk of developing cervical cancer within 3 years following a negative HPV test result was about half of the already low risk following a negative Pap test.
  • Cervical cancer risk within 3 years of a negative HPV test was similar to the risk of developing cancer within 5 years following a negative cotest.

A study by investigators at the National Cancer Institute of more than 1 million women has found that a negative test for human papillomavirus (HPV) infection is a more reliable predictor of the risk of developing cervical cancer than a negative Pap test. The findings suggest that primary HPV testing merits consideration as another alternative for cervical cancer screening. The study by Gage et al is published in the Journal of the National Cancer Institute.

Study Methodology

The NCI researchers used data from the Kaiser Permanente Northern California (KPNC) health-care system for their study. Since 2003, women between the ages of 30 and 64 enrolled in KPNC’s health system have had cervical cancer screening with concurrent HPV and Pap testing, allowing the researchers to compare the long-term risks of precancer and cancer after negative screening results in a large, established screening program. The data the researchers used represent the largest and longest experience with HPV testing in routine clinical practice and the risks from this population were used to develop current cervical screening and management guidelines, including those from the U.S. Preventive Services Task Force (USPSTF).

Using newly available screening data through 2012, the researchers extended their analysis to include more than 1 million women. They estimated cervical cancer risks among women who tested HPV-negative alone, Pap-negative alone, and cotest-negative. They then compared risk estimates based on USPSTF guidelines of Pap testing every 3 years and cotesting every 5 years.

Results

The researchers found that the risk of developing cervical cancer within 3 years following a negative HPV test result was about half of the already low risk following a negative Pap test. Cervical cancer risk within 3 years of a negative HPV test was similar to the risk of developing cancer within 5 years following a negative cotest.

The researchers estimated that these numbers of women would go on to develop cervical cancer following a negative test:

  • Pap-negative: 20 per 100,000 women over 3 years
  • HPV-negative: 11 per 100,000 women over 3 years
  • Cotest-negative: 14 per 100,000 women over 5 years

“We find that primary HPV testing every 3 years might provide as much, if not more, reassurance against precancer and cancer, compared to primary Pap testing every 3 years and cotesting every 5 years. Health decision analyses are now imperative to identify the optimal screening interval and preferred screening strategy,” concluded the researchers.

Julia C. Gage, PhD, MPH, of the National Cancer Institute, is the corresponding author for the Journal of the National Cancer Institute article.

For full disclosures of the study authors, visit jnci.oxfordjournals.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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