Human papillomavirus (HPV) DNA-based tests are more accurate than cytology (Pap smears) in detecting cervical precancerous lesions, according to data from a randomized controlled trial.

HPV screening, using DNA-based technology, was known to uncover more infections and precancerous lesions than cytology. It was unclear, however, whether it would lead to treatment of patients whose immune systems would clear up the problem on its own and thus did not need to be treated at all.

Guglielmo Ronco, M.D., Ph.D., of CPO Piemonte in Torino, Italy, and colleagues randomly assigned nearly 50,000 women to receive either conventional cytology, followed by a more intensive examination called colposcopy if abnormalities were detected, or to HPV-based screening and referral to colposcopy if the concentration of HPV DNA was above a predetermined level.

Using the HPV test, researchers identified nearly twice as many premalignant lesions, called CIN2+, than they did with cytology. Among older women ages 35 to 60, testing for HPV was more likely than conventional cytology testing to identify women who had cervical lesions. In women between the ages of 25 and 34, the HPV test appeared to identify a large number of infections that resolved themselves, even if they had some abnormal cells at the time of initial detection. Based on these data, Ronco and colleagues propose that it might be most appropriate for younger women with a positive HPV test to be retested in 12 months, rather than to be immediately referred for colposcopy.

"It seems clear that an HPV DNA-based approach to primary screening is a very attractive option that should be actively developed and evaluated," the authors write.

This research was published  March 25, 2008 in the Journal of the National Cancer Institute.