In this issue of The Lancet Oncology, Ronco and colleagues1 clarify the benefits and risks of introducing HPV-DNA testing into cervical cancer screening. In a large randomised trial, adding HPV-DNA testing to cytology doubled the detection of cervical intraepithelial neoplasia grade 3 (CIN3) compared with cytology alone, and (presumably, as a direct consequence) no cancers were observed during follow-up of the HPV-testing group compared with nine cases in the cytology group. As noted by the investigators, the increased detection of CIN3 was primarily due to HPV testing, since cytology added little to the sensitivity of screening when combined with HPV testing. These results are consistent with a trial from India2 that showed decreased cervical cancer incidence and mortality in the HPV-testing group (vs cytology and visual inspection with acetic acid). In Ronco and colleagues’ study, each of the nine women diagnosed with cervical cancers in the cytology group during follow-up had normal cytology at baseline. Four (44%) of these cancers were adenocarcinoma, a proportion four times greater than the expected, confirming that glandular cancers of the cervix are preferentially missed by cervical cytology.

source: Lancet oncology