HPV Tests Useful in ASCUS Cases

When a Pap test result is classified as atypical squamous cells of undetermined significance (ASCUS), a test for the human papillomarvirus (HPV) may be the best way to proceed, according to a new study reported in the January 18, 2006, issue of the Journal of the National Cancer Institute,

An HPV test would help a doctor to decide whether or not the patient should have more invasive testing. Conservative management with additional testing or immediate colposcopy were both shown to be less cost-effective.

The study involved 3,488 women with ASCUS results, who were randomly assigned to colposcopy, HPV triage followed by colposcopy if an oncogenic virus was found, or conservative management based on repeating the Pap test, with a referral to colposcopy if the patient had high-grade intraepithelial lesions.

Although the least costly stratety turned out to be conservative management with only one repeat Pap test, this method was found to detect the fewest number of precancer cases. While adding additional tests improved detection, it was less cost-effective. An immediate referral of the patient for colposcopy was shown to be cost-effective only if that procedure and a subsequent biopsy were assumed to be 100% sensitive.

In contrast, testing for HPV was both lest costly and a better predictor of precancer and cancer cases than either conservative management or immediate colposcopy.

The researchers, from the Duke Center for Clinical Health Policy Research (Durham, NC, USA; www.dukehealth.org), said that using the same money to reduce health-case disparities and to extend screening to under-screened groups "might have a greater impact on cervical cancer mortality than applying those resources to HPV triage of ASCUS.”






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