PCR-based high-risk HPV test in cervical cancer screening gives objective risk assessment of women with cytomorphologically normal cervical smears.
Cervical-cancer screening programmes using cytomorphological criteria could be more efficient if the screening included objective individual risk factors for women with normal cytology, such as a test for high-risk human papillomavirus (HPV). The value of a PCR-based test for high-risk HPV types was studied in a cohort of 1622 women presenting in a routine triannual population-based screening programme. Women were included in the study when they had no previous history of cervical dysplasia; and their initial Pap smear was read as normal (Pap 1 or 2). The mean age of the women was 42 years (range 34-54 years) and mean follow-up time was 40 months (range 5-73 months). Women were referred for colposcopically directed biopsies if they had had 2 successive cervical smears read as Pap 3a (mild to moderate dyskaryosis) or one read as > or = Pap 3b (severe dyskaryosis). Women with histologically confirmed cervical intraepithelial neoplasia grade III (CIN III) were considered positive cases. All women were tested for 14 high-risk HPV genotypes. Of the 86 high-risk HPV-positive women, 6 developed CIN III, whereas only 1 of the 1536 HPV-negative women did. The women with normal Pap smears containing high-risk HPV genotypes were 116 times (95% CI, 13-990) more at risk of developing CIN III, in contrast to women without high-risk HPV. These results support the view that the interval between successive smears in cervical-cancer screening can be increased considerably for women with cytomorphologically normal and high-risk HPV-negative cervical smears as determined by PCR.
Rozendaal
L
L
Department of Pathology, Free University Hospital, Amsterdam, The Netherlands.
Walboomers
J M
JM
van der Linden
J C
JC
Voorhorst
F J
FJ
Kenemans
P
P
Helmerhorst
T J
TJ
van Ballegooijen
M
M
Meijer
C J
CJ
D000328:Adult; D015331:Cohort Studies; D004279:DNA, Viral / Q000737:chemistry; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D000073718:Pancreatitis-Associated Proteins; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology*; D016133:Polymerase Chain Reaction / Q000379:methods; D012307:Risk Factors; D014412:Tumor Virus Infections / Q000453:epidemiology*; D002583:Uterine Cervical Neoplasms / Q000209:etiology / Q000517:prevention & control* / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000209:etiology / Q000517:prevention & control* / Q000821:virology
D004279:DNA, Viral; D000073718:Pancreatitis-Associated Proteins; C000612141:REG3A protein, human