• 7/1/2006
  • Manchester, England
  • H. C. Kitchener et al.
  • British Journal of Cancer (2006) 95, 56-61

To evaluate the effectiveness of human papillomavirus (HPV) testing in primary cervical screening:
This was a cross-sectional study from the recruitment phase of a prospective randomised trial. Women were screened for HPV in addition to routine cervical cytology testing. Greater Manchester, attendees at routine NHS Cervical Screening Programme.

In all, 24 510 women aged 20-64 screened with liquid-based cytology (LBC) and HPV testing at entry. HPV testing in primary cervical screening. Type-specific HPV prevalence rates are presented in relation to age as well as cytological and histological findings at entry. In all, 24 510 women had adequate cytology and HPV results. Cytology results at entry were: 87% normal, 11% borderline or mild, 1.1% moderate and 0.6% severe dyskaryosis or worse.

Prevalence of HPV decreased sharply with age, from 40% at age 20-24 to 12% at 35-39 and 7% or less above age 50. It increased with cytological grade, from 10% of normal cytology and 31% of borderline to 70% mild, 86% moderate, and 96% of severe dyskaryosis or worse. HPV 16 or HPV 18 accounted for 64% of infections in women with severe or worse cytology, and one or both were found in 61% of women with severe dyskaryosis but in only 2.2% of those with normal cytology. The majority of young women in Greater Manchester have been infected with a high-risk HPV by the age of 30.

HPV testing is practicable as a primary routine screening test, but in women aged under 30 years, this would lead to a substantial increase in retesting and referral rates. HPV 16 and HPV 18 are more predictive of underlying disease, but other HPV types account for 30% of high-grade disease.

Authors:
H C Kitchener1, M Almonte2, P Wheeler3, M Desai4, C Gilham5, A Bailey6, A Sargent7 and J Peto8,9 on behalf of the ARTISTIC Trial Study Group

Authors’ affiliations:
1Division of Human Development, University of Manchester, Hathersage Road, Manchester M13 0JH, UK

2Non-Communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK

3Division of Human Development, University of Manchester, Hathersage Road, Manchester M13 0JH, UK

4Department of Cytology, Central Manchester and Manchester Children’s University Hospitals NHS Trust, Oxford Road, Manchester M13 9WL, UK

5Cancer Research UK Epidemiology and Genetics Unit, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK

6Department of Virology, Central Manchester and Manchester Children’s University Hospitals NHS Trust, Oxford Road, Manchester M13 9WL, UK

7Division of Human Development, University of Manchester, Hathersage Road, Manchester M13 0JH, UK

8Non-Communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK

9Cancer Research UK Epidemiology and Genetics Unit, Institute of Cancer Research, Sutton, Surrey SM2 5NG, UK