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Randomised controlled trial
Single HPV test not useful for predicting CIN2 or worse or for guiding choice of further investigations for women aged 20-59 presenting to NHS Cervical Screening Programme with borderline abnormalities or mild dyskaryosis
  1. Ned Powell
  1. School of Medicine, Cardiff University, Cardiff, UK
  1. Correspondence to Ned Powell
    HPV Research Group, Obstetrics and Gynaecology, School of Medicine, Heath Park, Cardiff University, Cardiff CF14 4XN, UK; powellng{at}cf.ac.uk

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Context

There are many arguments supporting replacement of cytology with human papillomavirus (HPV) testing as the primary screen to prevent cervical cancer. Advantages include higher sensitivity, higher negative predictive value (NPV) (allowing longer screening intervals), potential for high-throughput screening and greater cost effectiveness. However, questions remain regarding how best to implement HPV testing, and its utility in specific subgroups. In the UK, the ARTISTIC trial investigated HPV testing as a primary screen1; the Sentinel Sites project and TOMBOLA study have investigated management of women with low-grade cytological abnormalities. The report by Cotton and colleagues describes the latest data from TOMBOLA.

Methods

The study population comprised of 4439 women, aged 20–59 years, with cytology results showing borderline nuclear abnormalities (BNA) or mild dyskaryosis, recruited in the East Midlands and two regions of Eastern Scotland during 1999–2002.

All women provided endocervical samples for HPV testing by GP5+/6+ PCR enzyme immuno assay performed at a single reference laboratory. Women were randomised to routine cytological surveillance or immediate colposcopy. Women in the immediate …

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