PCR-BASED HIGH-RISK HPV TEST IN CERVICAL-CANCER SCREENING GIVES OBJECTIVE RISK ASSESSMENT OF WOMEN WITH CYTOMORPHOLOGICALLY NORMAL CERVICALSMEARS

Cervical-cancer screening programmes using cytomorphological criteria could be more efficient a the screening included objective individual risk factors for women with normal cytology, such as a test for high-r isk human papillomavirus (HPV). The value of a PCR-based test for high -risk HPV types was studied in a cohort of 1622 women presenting in a routine triannual population-based screening programme. Women were inc luded in the study when they had no previous history of cervical dyspl asia; and their initial Pap smear was read as normal (Pap 1 or 2). The mean age of the women was 42 rears (range 34-54 years) and mean follo w-up time was 40 months (range 5-73 months). Women were referred for c olposcopically directed biopsies a they had had 2 successive cervical smears read as Pap 3a (mild to moderate dyskaryosis) or one read as gr eater than or equal to Pap 3b (severe dyskaryosis). Women with histolo gically confirmed cervical intraepithelial neoplasia grade III (CIN II I) were considered positive cases. AII women were tested for 14 high-r isk HPV genotypes. Of the 86 high-n'sk HPV-positive women, 6 developed CIN III, whereas only 1 of the 1536 HPV-negative women did. The women with normal Pap smears containing high-risk HPV genotypes were 116 ti mes (95% Cl, 13-990) more at risk of developing CIN III, in contrast t o women without high-risk HPV. These results support the view that the interval between successive smears in cervical-cancer screening can b e increased considerably for women with cytomorphologically normal and high-risk HPV-negative cervical smears as determined by PCR. (C) 1996 Wiley-Liss, Inc.