Editorials

Urine testing for HPV

BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g5542 (Published 16 September 2014) Cite this as: BMJ 2014;349:g5542
  1. Henry C Kitchener, professor and chair of gynaecological oncology,
  2. Gemma L Owens, academic clinical fellow in obstetrics and gynaecology
  1. 1Institute of Cancer Sciences, University of Manchester, St Mary’s Hospital, Manchester M13 9WL, UK
  1. Correspondence to: H C Kitchener henry.kitchener{at}manchester.ac.uk

A promising screening option that deserves further evaluation

Cervical screening has traditionally relied on samples of cervical cells, taken under direct vision by a doctor, using either a conventional cervical smear test or, more recently, liquid based cytology. The causal role of high risk types of human papillomavirus (HPV) in cervical carcinogenesis has led to the rigorous evaluation of HPV DNA testing of cervical samples in primary screening. A pooled analysis1 of four European randomised trials2 3 4 5 comparing cytology with cytology plus HPV testing over at least two screening rounds, reported that the combination increased protection by 60-70% compared with cytology alone. HPV testing is now set to replace cytology in several national screening programmes. HPV testing can be performed on self collected samples, including urine. In a linked paper (doi:10.1136/bmj.g5264) Pathak and colleagues report on the accuracy of HPV testing on urine samples compared with cervical samples obtained by a doctor.6

In recent years, coverage in cervical screening in the United Kingdom has fallen below 80%,7 particularly among women aged 25-30. Aside from possible increasing indifference to prevention among young women, documented …

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