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Previous Volume 357:1589-1597 October 18, 2007 Number 16 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Runowicz, C. D. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear Related Article

ABSTRACT

Background Screening for cervical cancer based on testing for human papillomavirus (HPV) increases the sensitivity of detection of high-grade (grade 2 or 3) cervical intraepithelial neoplasia, but whether this gain represents overdiagnosis or protection against future high-grade cervical epithelial neoplasia or cervical cancer is unknown.

Methods In a population-based screening program in Sweden, 12,527 women 32 to 38 years of age were randomly assigned at a 1:1 ratio to have an HPV test plus a Papanicolaou (Pap) test (intervention group) or a Pap test alone (control group). Women with a positive HPV test and a normal Pap test result were offered a second HPV test at least 1 year later, and those who were found to be persistently infected with the same high-risk type of HPV were then offered colposcopy with cervical biopsy. A similar number of double-blinded Pap smears and colposcopies with biopsy were performed in randomly selected women in the control group. Comprehensive registry data were used to follow the women for a mean of 4.1 years. The relative rates of grade 2 or 3 cervical intraepithelial neoplasia or cancer detected at enrollment and at subsequent screening examinations were calculated.

Results At enrollment, the proportion of women in the intervention group who were found to have lesions of grade 2 or 3 cervical intraepithelial neoplasia or cancer was 51% greater (95% confidence interval [CI], 13 to 102) than the proportion of women in the control group who were found to have such lesions. At subsequent screening examinations, the proportion of women in the intervention group who were found to have grade 2 or 3 lesions or cancer was 42% less (95% CI, 4 to 64) and the proportion with grade 3 lesions or cancer was 47% less (95% CI, 2 to 71) than the proportions of control women who were found to have such lesions. Women with persistent HPV infection remained at high risk for grade 2 or 3 lesions or cancer after referral for colposcopy.

Conclusions The addition of an HPV test to the Pap test to screen women in their mid-30s for cervical cancer reduces the incidence of grade 2 or 3 cervical intraepithelial neoplasia or cancer detected by subsequent screening examinations. (ClinicalTrials.gov number, NCT00479375 [ClinicalTrials.gov] .)

Source Information

From the Department of Medical Microbiology, Malmö University Hospital, Lund University (P.N., O.F., B.-G.H., J.D.); the Department of Pathology and Clinical Cytology (W.R.), the Department of Obstetrics and Gynecology (T.R., B.S.), and the Oncology Center (B.S.), Sahlgrenska University Hospital, Gothenburg; the Cancer Screening Unit, Oncology Center (S.T.), the Department of Obstetrics and Gynecology (K.E.), and the Department of Clinical Microbiology (B.J.), Karolinska University Hospital, and the Division of Gynecology, Danderyd Hospital (E.R.), Karolinska Institutet, Stockholm; the Department of Medicine, Dermatology, and Venereology, University Hospital, Uppsala (A.S.); and the Department of Virology, University of Northern Sweden, Umeå (G.W.) — all in Sweden.

Address reprint requests to Dr. Dillner at the Department of Medical Microbiology, Lund University, Malmö University Hospital, Malmö S-20502, Sweden.

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