Research

Effect of testing for human papillomavirus as a triage during screening for cervical cancer: observational before and after study

BMJ 2006; 332 doi: 10.1136/bmj.38701.440961.7C (Published 12 January 2006)
Cite this as: BMJ 2006;332:83
  1. Sue Moss, associate director (sue.moss{at}icr.ac.uk)1,
  2. Alastair Gray, professor of health economics2,
  3. Rosa Legood, senior researcher2,
  4. Martin Vessey, emeritus professor of public health3,
  5. Julietta Patnick, director4,
  6. Henry Kitchener, professor of gynaecological oncology, Liquid Based Cytology/Human Papillomavirus Cervical Pilot Studies Group5
  1. 1 Cancer Screening Evaluation Unit, Institute of Cancer Research, Sutton, Surrey SM2 5NG
  2. 2 Health Economics Research Centre, Department of Public Health, University of Oxford, Oxford OX3 7LF
  3. 3 Unit of Health Care Epidemiology, Department of Public Health, University of Oxford, Oxford OX3 7LF
  4. 4 NHS Cancer Screening Programmes, Sheffield S10 3TH
  5. 5 University of Manchester, St Mary's Hospital, Manchester M13 0JH
  1. Correspondence to: S Moss
  • Accepted 14 December 2005

Abstract

Objective To assess the effect of introducing testing for human papillomavirus combined with liquid based cytology in women with low grade cytological abnormalities.

Design Observational before and after study.

Setting Three cervical screening laboratories, England.

Participants 5654 women aged 20-64 with low grade cytological abnormalities found at routine cervical screening in a pilot; 5254 similar women in the period before the pilot.

Interventions Human papillomavirus testing combined with liquid based cytology in the management of women with borderline or mildly dyskaryotic cervical smear results compared with conventional smear tests, with immediate referral to colposcopy of women positive for human papillomavirus.

Results 57.9% (3187/5506) of women tested in the pilot were positive for human papillomavirus. The rate of repeat smears fell by 74%, but the rate of referral to colposcopy for low grade cytological abnormalities more than doubled. The estimated negative predictive value of human papillomavirus testing varied between 93.8% and 99.7%.

Conclusion The addition of testing for human papillomavirus in women with low grade cytological abnormalities resulted in a reduction in the rate of repeat smears, but an increase in rates of referral to colposcopy.

Footnotes

  • Embedded ImageMembers of the pilot studies group are on bmj.com

    This article was posted on bmj.com on 6 January 2006:http://bmj.com/cgi/doi/10.1136/bmj.38701.440961.7C

    Editorial by Schiffman and Castle and p 79

    This study forms part of the independent evaluation of the liquid based cytology/human papillomavirus cervical screening pilot studies commissioned by the Policy Research Programme at the Department of Health. The evaluation was carried out by research teams at the Cancer Screening Evaluation Unit, Institute of Cancer Research (SM, E Henstock), the Health Economics Research Centre, University of Oxford (AG, RL), and the Psychology and Genetics Research Group, King's College London (T Marteau, E Maissi). The views expressed are those of the authors and not necessarily those of the Department of Health.

  • Contributors SM led the evaluation team and is the guarantor. AG and RL participated in the evaluation. MV and JP contributed to the design of the study. HK contributed to the design of the study and chaired the steering group for the pilot studies.

  • Funding Department of Health Policy Research Programme.

  • Competing interests None declared.

  • Ethical approval Not required.

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