New Danish publication presenting the benefits of PreTect HPV-Proofer in the management of ASC-US/LSIL in young women.
Adopting primary HPV screening, young women continue to be screened by cytology, among whom the findings of ASC-US/LSIL are common. To obtain the best possible balance between reducing the risk of cervical cancer and limiting over-management, the choice of management strategy becomes essential.
The cohort study recently published by St-Martin et al, investigated how different management strategies used in Denmark influenced biopsy rates and detection of cervical intra-epithelial neoplasia (CIN) by comparing 5 main strategies: repeat cytology, 14-type mRNA test, 5-type mRNA test, DNA test or direct referral to colposcopy.
See excerpt from the text below.
Figure 1. Relative risks for CIN3+, CIN2 and < CIN2 with HPV test or direct referral to colposcopy compared to repeat cytology. Results adjusted for index diagnosis and birth year.
“Main findings: The strategy used had an impact on the benefits and the harms of cervical screening of these young women. The detection of CIN3+ was somewhat higher, 13% to 14% with HPV testing vs. 11% with repeat cytology. Compared with repeat cytology, HPV testing led to more women undergoing biopsy, and more women had biopsies that turned out normal or with CIN1-2 which does not indicate treatment.
A specific triage test with a low positivity rate translates into a low referral rate for colposcopy, which is very appealing for triage situations. In our material, the 5-type HPV mRNA test was the most specific triage test.
Except for 5-type mRNA test, the relative risks for biopsies with < CIN2 were higher than the relative risks for high grade lesions, indicating over-management. The risk of having biopsies not indicating treatment was approximately doubled with 14-type mRNA test (2.11) or HPV DNA test (1.86) and almost tripled with direct referral to colposcopy (2.80).
In conclusion, the optimal strategy for assessment of ASCUS and LSIL is still not clear, and the choice will depend on the health authorities’ and women’s preferred balance between benefits and harms. Based on our study, repeat cytology or triage with 5-type mRNA test seems to offer advantages compared to HPV testing in terms of fewer unnecessary biopsies”.
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