Human papillomavirus tests could decrease deaths from cervical cancer

16 January 2006

Cancer technology researchers say that more lives might be saved cost-effectively by applying human papillomavirus testing to women with borderline cervical smear results. The researchers, from the University of Oxford and the Institute of Cancer Research in London, published the results of their study in the 14 January edition of the British Medical Journal.

The researchers caution, however, that the gain in life would need to be balanced against more frequent visits to hospital for follow-up investigations with a microscopic camera known as a coloscope.

There are almost 3,000 new cases of cervical cancer in the UK each year according to the charity Cancer Research UK, and it is the second most common cancer in women under the age of 35. A simple treatment can usually prevent the disease from developing if the abnormal cells which produce it are caught early.

‘The gain in life expectancy which we observed with the papillomavirus testing is related to referring patients that test positive for the virus, and are therefore at higher risk of developing cervical cancer, for immediate follow-up investigation at the hospital’ said Rosa Legood, a senior researcher with the Oxford Health Economics Research Centre. ‘It is also related to stemming the loss of women from the programme who fail to attend after borderline cytology results because of the number of follow-up tests.’

Currently the UK Cervical Cancer Screening Programme asks women with mildly abnormal or borderline cervical smear results to submit to tests every six months untiltwo to three consecutive tests do not reveal any abnormalities. This can be costly for the patients and the NHS and can still miss the lesions leading to cancer, while some women may neglect to return for the follow-up screenings.

Testing for the presence of the sexually transmitted human papillomavirus, which causes genital warts, could instead help to determine whether to order an immediate hospital investigation. Some strains of the virus are thought to be the major cause of the cancer.

‘Tumor-causing human papillomavirus has been detected in almost all invasive cancers, and its prevalence in precancerous lesions varies from about eighty to ninety percent,’ said Ms Legood. ‘However, human papillomavirus can often regress naturally and does not necessarily lead to cervical cancer.’

The researchers analyzed data from three laboratories which the Department of Health chose in 2001 as pilot sites for the use of human papillomavirus testing and of Liquid Based Cytology, with which the NHS is gradually replacing the Pap smear. They calculated the additional cost to the government of each year of patient life saved based upon the predicted gain in life expectancy and costs including that of screening, hospital investigation and cancer treatment.

The researchers included health economists Rosa Legood, Professor Alastair Gray and Dr Jane Wolstenholme from the Health Economics Research Centre in the Oxford Department of Public Health, and Dr Sue Moss from the Institute of Cancer Research in London.

For more information contact the Press Office on 01865 280534 or email press.office@admin.ox.ac.uk

Notes to Editors:

• Cancer Research UK reports that cervical cancer caused 1,120 deaths in the United Kingdom in 2002. The problem is far greater in countries where medical care is less available, with 274,000 women worldwide dying from invasive carcinoma of the cervix each year.
• The paper, entitled ‘Lifetime effects, costs, and cost effectiveness of testing for human papillomavirus to manage low grade cytological abnormalities: modelling study,’ was published in Volume 332, No. 7533, pp 79-85 of the BMJ on 14 January.