HPV DNA Testing in Cervical Cancer Screening: Results from Women in a High‐Risk Province of Costa Rica

Abstract

JAMA 2000;283:87–93 The study investigated human papillomavirus (HPV) testing to screen for cervical cancer in 8554 sexually active, non-pregnant women over the age of 18 years in a Costa Rican province. Participants underwent a collection for a conventional Pap smear and a thin-layer Pap smear (Cytec Corp., Marlborough, MA), and a separate specimen for a first generation and later a second generation test for HPV DNA. After collection of the cervical cells two cervical photographs (Cervigram, National Testing Laboratories, Fenton, MO) were taken after the application for expert screening. Patients with a gross cervical lesion, an abnormal Pap smear, or an abnormal cervigram were referred for colposcopic examination. The combination of highest specificity and sensitivity was found in the second generation DNA hybridization test, identifying all 12 patients with cervical cancer and 88% of the 136 subjects with CIN2 or CIN3 when an HPV DNA level of 1.0 pg/ml was used as the threshold for colposcopic referral. Comment: The results of this study have been long awaited. It showed that HPV testing may have a role in screening for cervical cancer, but the role remains undefined. This study shows that HPV DNA testing may increase the sensitivity for detecting CIN over that of conventional cytology, but it produces a large number of false positives because of its lower specificity and as yet undefined clinical cutoff criteria. It is likely these tests will have more consumer appeal from these results, but the fact remains that the worldwide problem in the detection of cervical cancer is that there is no cost-efficient, widely available method to test the groups at highest risk for cervical cancer. There is no doubt HPV DNA testing is a worthwhile investigational tool, but exactly how it should be used remains unclear. (TMJ)