HPV-positive test less likely than previously reported

The incidence of a positive carcinogenic human papillomavirus (HPV) test in a general population of women is less likely than previously reported, suggesting concerns over HPV testing in general clinical practice may be overstated, according to research published in the March issue of Obstetrics and Gynecology.

Philip E. Castle, PhD, of the National Cancer Institute in Bethesda, MD, and colleagues estimated the 5-year age group-specific rate of positive Pap and HPV tests (performed as 797,927 co-tests) in a group of 580,289 women (average age 46 years) between 2003 and 2008. Pap tests showing atypical squamous cells of undetermined significance or more severe were considered positive. The Hybrid Capture 2 assay was used to determine carcinogenic HPV status.

The investigators found that, overall, 6.27% of the co-tests were HPV-positive. A total of 3.99% of the co-tests were HPV-positive but had normal cytology by Pap smear. In comparison, 5.18% of co-tests were Pap-positive. Women aged 30 to 34 years were most likely to have a positive HPV test or a positive Pap test. A positive Pap result and negative HPV result, most likely in women aged 45 to 49 years, was observed in 3.77% of co-tests, the researchers report.

“The development of a viable strategy for identifying the subset of Pap-negative, HPV-positive women at highest risk of cervical intraepithelial neoplasia grade 3 or more severe would further improve the efficiency of secondary cervical cancer prevention,” the authors write.

Castle PE, Fetterman B, Poitras N, et al. Five-year experience of human papillomavirus DNA and Papanicolaou test cotesting. Obstet Gynecol. 2009;113:595-600.