Nature Medicine | Spoonful of Medicine

Largest study of home-testing for HPV underscores its promise — and problems

hpv-pap-.jpgIt’s an understatement to say that HPV has made headlines in recent weeks, but there’s another way the virus might be hitting home. While a clinic-based DNA test for the virus received regulatory approval in the US in 2000, researchers are now exploring the possibility of at-home testing to screen for the pathogen.

The first randomized controlled trial of self-sampling for human papillomavirus (HPV), published today in The Lancet, ultimately found that this tool picked up more premalignant cervical cancers than in-clinic pap smears in women in poor regions of Mexico. The study, the largest to date with more than 20,000 participants, suggests that at-home testing could be a good solution for women living in areas where hospitals are few and far between.

“The main goal was to see which approach was the most sensitive in detecting the most cancers, and really find out what might be the indications of use for this test in terms of effectiveness,” says paper author and trial organizer Attila Lorincz, a molecular epidemiologist at Barts and The London School of Medicine and Dentistry.

In a study of more than 20,000 women, Lorincz and his colleagues randomly invited half to either self-collect a tiny amount of cervical cells by swab, advised by a visiting clinician, for DNA testing or to pop into a clinic for a pap smear to look for abnormal cell growth associated with cervical cancer, called cervical intraepithelial neoplasia (CIN). Of those invited in each respective group, 98% and 87% accepted, suggesting that women were more willing to undergo testing at home.

Women who tested positive for HPV using the DNA assay or with abnormal cell growth received a biopsy or colposcopy to confirm CIN. The at-home DNA testing identified 884 women who required follow-up biopsies or screening, of whom 108, or 12%, had CIN. By comparison, 42 women who received pap smears had to undergo more rounds of testing, and 38 of those had CIN, which translates into 90%.

The results underscore how home-testing might produce more false-positives under these circumstances. But the findings also point to the fact that the DNA-based test picks up HPV strains that may never cause cancer, for which reason the US Preventive Services Task Force declined to recommend the test to women under 30 years on 19 October.

The authors of the study say that at-home DNA screening is a good way to reach women who would otherwise go untested but receiving follow-up treatment remains a challenge in these areas that have few clinics.

Image: via Flickr user Ed Uthman under Creative Commons licensing


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