Some Watchful Waiting OK for Human Papillomavirus
Two studies investigate different testing schemes for cervical changes; natural history of virus
WEDNESDAY, March 26 (HealthDay News) -- In two studies in the April 2 issue of the Journal of the National Cancer Institute, researchers report on the usefulness of conventional cytology versus human papillomavirus (HPV) testing for detecting cervical intraepithelial neoplasia of grade 2 or more (CIN2+), as well as an assessment of the natural history of cervical HPV infection.
In the first study, Guglielmo Ronco, M.D., Ph.D., of the Centro per la Prevenzione Oncologica in Turin, Italy, and colleagues report on the second phase of a screening study in which over 49,000 women were randomized either to conventional cytology with a referral to colposcopy if the results showed a low-grade squamous intraepithelial lesion or higher, or to testing for high-risk viral DNA and, if the test was positive at 1 pg/mL cutoff, they were referred to colposcopy. The investigators found that in women aged 35 to 60, HPV testing with a cutoff of 2 pg/mL offers substantially greater sensitivity compared to conventional cytology with only a small loss of positive predictive value. Younger women frequently showed regression of CIN2+ lesions, so HPV-positive women aged 25 to 34 should only be referred to colposcopy if their cytology is abnormal or infection lasts for a year.
In the second study, Ana Cecilia Rodriguez, M.D., of the National Cancer Institute in Rockville, Md., and colleagues report on data from 599 women with HPV infection. Two-thirds of the infections cleared within a year, and among the remaining infections, 21 percent were associated with a CIN2+ diagnosis by 30 months, they report.
"These data suggest that, when possible, a patient with a normal cytology and initial positive HPV result should be managed with watchful waiting because a 12-month follow-up can safely exclude more than 50 percent of infections as transient. Once type-specific HPV infections can be reliably detected by well-validated assays, new screening and management guidelines will need to be developed that incorporate these natural history data," Rodriguez and colleagues write.