HPV Testing Worthwhile in Cervical Neoplasia Follow-Up

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NEW YORK (Reuters Health) Apr 25 - Human papillomavirus (HPV) testing after treatment for cervical intraepithelial neoplasia (CIN) appears to be cost effective, Dutch researchers report in the April issue of BJOG. In fact, it may be cheaper than current approaches.

"In most western European countries," lead investigator Dr. Veerle M. H. Coupe told Reuters Health, "follow-up after treatment for CIN2/3 is currently based on cytological testing at 6, 12, and 24 months."

To investigate whether adjunct HPV testing might be a more useful strategy, Dr. Coupe and colleagues at VU Medical Centre, Amsterdam developed a computer-based mathematical model including data from three Dutch follow-up studies and a Dutch screening cohort.

The simulation was tested in various health situations. Among these were successful treatment, with both CIN and high-risk HPV being absent, unsuccessful CIN treatment with persistent HPV-positive CIN2/3, and development of invasive cancer.

At 5 years, strategies using HPV testing led to a reduction in missed CIN2/3 cases of 32% to 77%. "Moreover," continued Dr. Coupe, "adjunct HPV testing allows for a decrease in the number of repeat smears without increasing the colposcopy rate. Implementation can be achieved without increasing costs."

A particularly attractive strategy, the investigators point out, was HPV testing alone at 6 months and both HPV and cytological testing at 24 months after treatment.

As well as being highly effective, they conclude, this approach "was 49 Euros per woman cheaper than the current strategy."

BJOG 2007;114:416-424.

Source: http://www.medscape.com/viewarticle/555723?src=mp