Management of women who test positive for high-risk types of human papillomavirus: the HART study
- PMID: 14667741
- DOI: 10.1016/S0140-6736(03)14955-0
Management of women who test positive for high-risk types of human papillomavirus: the HART study
Abstract
Background: Certain types of human papillomavirus (HPV) are the primary cause of almost all cervical cancers. HPV testing of cervical smears is more sensitive but less specific than cytology for detecting high-grade cervical intraepithelial neoplasia (CIN2+). HPV testing as a primary screening approach requires efficient management of HPV-positive women with negative or borderline cytology. We aimed to compare the detection rate and positive predictive values of HPV assay with cytology and to determine the best management strategy for HPV-positive women.
Methods: We did a multicentre screening study of 11085 women aged 30-60 years. Women with borderline cytology and women positive for high-risk HPV with negative cytology were randomised to immediate colposcopy or to surveillance by repeat HPV testing, cytology, and colposcopy at 12 months.
Findings: HPV testing was more sensitive than borderline or worse cytology (97.1% vs 76.6%, p=0.002) but less specific (93.3% vs 95.8%, p<0.0001) for detecting CIN2+. Of 825 randomised women, surveillance at 12 months was as effective as immediate colposcopy. In women positive for HPV at baseline, who had surveillance, 73 (45%) of 164 women with negative cytology and eight (35%) of 23 women with borderline cytology were HPV negative at 6-12 months. No CIN2+ was found in these women, nor in women with an initial negative HPV test with borderline (n=211) or mild (32) cytology.
Interpretation: HPV testing could be used for primary screening in women older than 30 years, with cytology used to triage HPV-positive women. HPV-positive women with normal or borderline cytology (about 6% of screened women) could be managed by repeat testing after 12 months. This approach could potentially improve detection rates of CIN2+ without increasing the colposcopy referral rate.
Comment in
-
Are we ready for a paradigm change in cervical cancer screening?Lancet. 2003 Dec 6;362(9399):1866-7. doi: 10.1016/S0140-6736(03)14996-3. Lancet. 2003. PMID: 14667737 No abstract available.
-
HPV testing may replace Pap smears for primary screening.J Fam Pract. 2004 Apr;53(4):266-8. J Fam Pract. 2004. PMID: 15068770 No abstract available.
Similar articles
-
The clinical effectiveness and cost-effectiveness of primary human papillomavirus cervical screening in England: extended follow-up of the ARTISTIC randomised trial cohort through three screening rounds.Health Technol Assess. 2014 Apr;18(23):1-196. doi: 10.3310/hta18230. Health Technol Assess. 2014. PMID: 24762804 Free PMC article. Clinical Trial.
-
Human papillomavirus test with cytology triage in organized screening for cervical cancer.Acta Obstet Gynecol Scand. 2016 Nov;95(11):1220-1227. doi: 10.1111/aogs.13013. Acta Obstet Gynecol Scand. 2016. PMID: 27591407
-
Performance of carcinogenic human papillomavirus (HPV) testing and HPV16 or HPV18 genotyping for cervical cancer screening of women aged 25 years and older: a subanalysis of the ATHENA study.Lancet Oncol. 2011 Sep;12(9):880-90. doi: 10.1016/S1470-2045(11)70188-7. Epub 2011 Aug 22. Lancet Oncol. 2011. PMID: 21865084 Clinical Trial.
-
Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions.Cochrane Database Syst Rev. 2013 Mar 28;2013(3):CD008054. doi: 10.1002/14651858.CD008054.pub2. Cochrane Database Syst Rev. 2013. PMID: 23543559 Free PMC article. Review.
-
[Health technology assessment report. Use of liquid-based cytology for cervical cancer precursors screening].Epidemiol Prev. 2012 Sep-Oct;36(5 Suppl 2):e1-e33. Epidemiol Prev. 2012. PMID: 23139163 Review. Italian.
Cited by
-
A Glimmer of Hope for Patients with a T3 Transformation Zone: miRNAs Are Potential Biomarkers for Cervical Dysplasia.Diagnostics (Basel). 2023 Dec 5;13(24):3599. doi: 10.3390/diagnostics13243599. Diagnostics (Basel). 2023. PMID: 38132183 Free PMC article.
-
HPV pathogenesis, various types of vaccines, safety concern, prophylactic and therapeutic applications to control cervical cancer, and future perspective.Virusdisease. 2023 May 24;34(2):1-19. doi: 10.1007/s13337-023-00824-z. Online ahead of print. Virusdisease. 2023. PMID: 37363362 Free PMC article. Review.
-
CIN2 + detection in high-risk HPV patients with no or minor cervical cytologic abnormalities: a clinical approach validated by machine learning.Arch Gynecol Obstet. 2023 Mar;307(3):881-890. doi: 10.1007/s00404-023-06953-6. Epub 2023 Feb 13. Arch Gynecol Obstet. 2023. PMID: 36780042 Free PMC article.
-
Comparative accuracy of cervical cancer screening strategies in healthy asymptomatic women: a systematic review and network meta-analysis.Sci Rep. 2022 Jan 7;12(1):94. doi: 10.1038/s41598-021-04201-y. Sci Rep. 2022. PMID: 34997127 Free PMC article.
-
Clinicopathologic significance and treatment of ASC-US in cervical cytology.Int J Clin Exp Pathol. 2020 Feb 1;13(2):307-316. eCollection 2020. Int J Clin Exp Pathol. 2020. PMID: 32211114 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical