title: Human papillomavirus testing with conventional Pap smear screening in three inner London community clinics.
abstract: METHODS
  This observational study aimed to establish prevalence of high-risk human papillomaviruses (hrHPV) in women attending three inner London community clinics for routine screening and to pilot hrHPV testing in the triage of either borderline or negative cytology after previous abnormalities. Hybrid Capture 2 was carried out on brush samples taken alongside conventional smears from 1434 women aged 20-49 years. hrHPV positivity prompted earlier referral of women with previous abnormalities and either low-grade or negative cytology. Outcome at colposcopy was compared with the records of 1871 women aged 20-49 years attending colposcopy during the same period of time (routine colposcopies).
  
  
  RESULTS
  hrHPV was detected in 111/161 (68.9%) women with abnormal cytology, 76/460 (16.5%) with negative cytology after previous abnormalities and 105/813 (12.9%) with negative cytology and no previous abnormalities. Overall, hrHPV was detected in 292/1434 (20.4%) women in the study (95% CI 18.3-22.5). hrHPV prevalence increased with severity of cytological abnormality (p<0.001) and decreased with age both with negative and low-grade cytology (p<0.001). High-grade cervical intraepithelial neoplasia (CIN) biopsies were found more frequently in women in the study groups with low-grade (p<0.001) or negative cytology than in routine colposcopies, but more women in the study groups attended colposcopy (8.2% compared with 4.1% routine colposcopies, p<0.001).
  
  
  CONCLUSIONS
  hrHPV positivity increased detection of high-grade CIN in the study groups at the expense of more colposcopies. hrHPV negativity could reduce the need for investigation of low-grade cytology in women aged over 35 years and for surveillance after previous abnormalities.
authors.affiliation: Histopathology Department, St Thomas' Hospital, London, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Herbert
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Best
authors.forename: Parmjit
authors.initials: P
authors.lastname: Chana
authors.forename: Elena
authors.initials: E
authors.lastname: Ktori
authors.forename: Margaret
authors.initials: M
authors.lastname: Nowicki
authors.forename: Hilda
authors.initials: H
authors.lastname: Dunsmore
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Culora
authors.forename: Marc
authors.initials: M
authors.lastname: Arbyn
authors.forename: Ali A
authors.initials: AA
authors.lastname: Kubba
mesh_terms: D000328:Adult; D017677:Age Distribution; D003127:Colposcopy; D003153:Community Health Services; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology*; D010865:Pilot Projects; D011159:Population Surveillance; D015995:Prevalence; D014505:Urban Population / Q000706:statistics & numerical data*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology
chemical_list: D004279:DNA, Viral