The NHS is to start screening women for human papilloma-virus (HPV) if they have a mild or borderline cervical smear result. Women who test positive for the virus will then be “fast tracked” for further investigation and treatment.
The pilot scheme will start this summer and run for a year at three sites as part of the NHS cervical screening programme. The UK National Screening Committee recommended the move following the publication of a report from the Health Technology Assessment programme last September (www.hta.nhsweb.nhs.uk). This said that the evidence supported testing for human papilloma-virus when a smear showed borderline nuclear change and mild dyskariosis.
A spokeswoman for the Department of Health said: “We are fine tuning the programme in order to get women with borderline smear results who are HPV positive seen as quickly as possible for further investigation as we know it is this group of women who are more likely to get cervical cancer.”
Women who test negative for the virus will be called back for a repeat smear six months later, as happens now, and for a second test for the virus. If the smear shows no progression to a high grade abnormality and the test is negative again, the woman will be discharged back to the normal screening cycle.
The human papillomaviruses are a group of more than 80 different types of virus, including those causing genital warts. They can be transmitted through sexual intercourse and have been linked to cervical cancer.
Most human papillomavirus infections disappear without treatment, and even women who develop types of the virus associated with cancer rarely go on to develop cervical cancer.
Professor Jack Cuzick, head of mathematics, statistics, and epidemiology at the Imperial Cancer Research Fund, London, welcomed the pilot screening programme: “The lives saved will be relatively modest, probably 50-100 a year. But it should lead to better management of cervical smears and possible cost savings as women don't have to be called back so often.”
Professor Cuzick said, however, that the NHS needed to invest in new technology and carry out the test for human papillomavirus using liquid cytology. Liquid cytology entails placing the smear sample into a liquid storage tube for transporting so that an improved smear test can be made in a laboratory and other tests can be done with remaining cells. The technique is currently being evaluated by the National Institute for Clinical Excellence.
“Using liquid cytology the sample is easier to read and gives more accurate results, and because you can go back to the sample you don't need to call women back for a second smear,” said Professor Cuzick. Screening for the virus using liquid cytology is already carried out in some parts of the world—for example, in Geneva.
Professor Cuzick added that the government should urgently fund a large study to evaluate screening women in the general population for human papilloma-virus.