A STUDY designed to assess the first 6 months after the National Cervical Screening Program switched from cytology- to primary HPV-based screening is the winner of the 2019 MJA/MDA National Prize for Excellence in Medical Research, for the best research article published in the Medical Journal of Australia in the previous calendar year.
The winning article -- Routine cervical screening by primary HPV testing: early findings in the renewed National Cervical Screening Program – was authored by Dr Dorothy Machalek and Professor Suzanne Garland, from the Centre for Women's Infectious Diseases at Royal Women's Hospital, Melbourne and the University of Melbourne; Adjunct Professor Annabelle Farnsworth, Medical Director of Douglass Hanly Moir Pathology and her colleagues, Dr Jennifer Roberts, Julia Thurloe, Adele Richards, Dr Ian Chambers and Terri Sivertsen.
The study was a retrospective cross‐sectional review of 195 606 specimens submitted to Douglass Hanly Moir Pathology for human papillomavirus (HPV) testing between December 2017 and 31 May 2018.
The main outcome measures were prevalence of oncogenic HPV types (all, HPV16/18, non‐HPV16/18) by reason for HPV test (primary screening, non‐screening); for oncogenic HPV‐positive women in the age band recommended for primary HPV screening (25–74 years), prevalence of cytologic abnormality and rates of 12‐month follow‐up and colposcopy recommendations.
During the study period, 195 606 samples were received: 157 700 (80.6%) for primary screening, 37 906 (19.4%) for non‐screening tests. Oncogenic HPV was detected in 8.1% of screening tests (95% CI, 7.9–8.2%) and 20.9% of non‐screening tests (95% CI, 20.5–21.3%); 35.5% (95% CI, 34.7–36.4%) of women of recommended screening age with positive oncogenic HPV screening test results also had a cytologic abnormality. The proportion of HPV16/18‐positive samples with high grade abnormality was 15.3% (95% CI, 14.2–16.6%); for samples positive for other oncogenic HPV types, the proportion was 6.3% (95% CI, 5.8–6.8%). Repeat HPV testing after 12 months was recommended for 5.4% (95% CI, 5.3–5.5%) and direct colposcopy for 2.6% (95% CI, 2.5–2.7%) of screened women aged 25–74 years.
“High grade cytologic abnormalities were more common in women positive for HPV16/18, supporting their higher risk classification,” the authors found.
“Colposcopy referral rates were higher than during primary cytology‐based testing, as predicted by clinical trial and modelling data. The prevalence of HPV was much higher in non‐screening than in primary screening samples.
“These early observations suggest the renewed program is performing as expected during the first screening round, but timely program monitoring is critical for ensuring community confidence in the new policy.”
Sponsored by MDA National, this prize awards the authors $10 000 in cash.
The winning study is online at https://www.mja.com.au/journal/2019/211/3/routine-cervical-screening-primary-hpv-testing-early-findings-renewed-national and is open access.
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- Cate Swannell