A whole-population profile of HPV testing as a test of cure for high-grade cervical dysplasia in NSW, Australia

Abstract

Introduction: Few population-based studies have been conducted on the efficacy of human papilloma virus (HPV) testing as a test of cure for high grade cervical dysplasia. Methods: A cohort of women (n ¼ 11,521) with high grade (CIN2þ) cervical dysplasia diagnosed during 2006-2010, who also had accompanying HPV testing (n ¼ 19,434 HPV tests), was analyzed with respect to National Health and Medical Research Council (NHMRC) follow-up guidelines. Cure rates, and number of follow-up tests and times to reach a cure were estimated. Results: In the 52-years following high grade dysplasia, 53% of women had a single follow-up HPV test, 33% had two, and 14% had three or more HPV follow-up tests. 75% of women with follow-up HPV and cytology testing according to NHMRC guidelines were cured (2,210 from 2,948). Cure rates were lowest in those aged <30 (71%) and highest in women aged 30-49 (80%). Of those cured, 68% attained cure by the second HPV test, 21% by the third, and 11% at the fourth or later HPV test. The median time to cure was 1,097 days. In non-cured women, 56% of test results originated from all-negative cytology with positive HPV, compared with 9% from all-negative HPV results. Conclusions: Cure rates in women with follow-up testing according to NHMRC guidelines are high. Further studies are needed of the high proportion of women with negative cytology classed as not cured due to HPV positivity, and of the high proportion of women with high grade dysplasia who had one follow-up HPV test only.

The human papillomavirus Test of Cure: A lesson on compliance with the NHMRC guidelines on screening to prevent cervical cancer

“…The results here indicate that an overall low ToC completion rate is similar to findings recently reported in a New South Wales retrospective study . As reported by Morrell and Qian, it is possible that general practitioners and other women's health clinicians believe that a single HR HPV‐negative test result, along with successive negative cytology, is sufficient to indicate successful treatment.…”

“…This management pathway returns eligible women back to routine screening (two yearly) and reduces previously required post‐treatment surveillance frequency . Multiple follow‐up studies have shown HR HPV testing to be efficacious for detecting residual or recurrent disease inpatients treated for HSIL …”

Awareness and knowledge of human papilloma virus in UK women aged 25 years and over: Results from a cross‐sectional internet‐based survey

“…For example, in England, HPV testing is used to triage cytology tests showing borderline changes or low-grade dyskariosis, reducing the number of women on early recall, and speeding up colposcopy follow-up for those with high-risk HPV (Kelly et al, 2011;Kitchener et al, 2009). In the UK and Australia, HPV testing is also used as a 'test of cure' for treatment of cervical abnormalities, allowing women to return to regular screening if no high-risk HPV infection is detected (Kitchener et al, 2008;Kitchener et al, 2013;Morrell & Qian, 2014). The UK NHS cervical screening programme will change to HPV primary testing in 2019 (Rebolj et al, 2019).…”