Cervical cancer is still the most common cancer in women under 35 years of age. Although the screening programme is very well established in the UK, there has actually been a reduction in women under 35 years attending for cervical screening in recent years.
As infection with human papillomavirus (HPV) is associated with the development of cervical cancer, the detection of HPV in the cervix has been piloted as a new way of cervical cancer screening. This method may actually be more protective of precancerous cervical changes and invasive cervical cancer than current cytology-based screening methods.
A recent systematic review* and meta-analysis in The BMJ has found that urine tests may offer a more accessible and acceptable method for detecting HPV, which could improve screening uptake among women reluctant to attend.
Among women whose HPV status had already been determined by prior cervical testing, these urine tests correctly identified 87% of positive HPV cases and 94% of negative cases. Test accuracy increased when samples were taken from the patient’s first urination of the day.
The low false positive rate means that potentially this could lead to less women undergoing unnecessary invasive investigations, including cytology, colposcopy, or biopsy, to prove lack of disease. These unnecessary investigations can lead to increased anxiety and costs.
The authors do state that these results need to be interpreted with caution due to variation between individual studies for participant characteristics, lack of standardised methods of urine testing, and the surrogate nature of cervical HPV for cervical disease. However, this type of testing could potentially be very beneficial for hard-to-reach groups of women who would otherwise not attend for screening.
* Neha Pathak, et al. Accuracy of urinary human papillomavirus testing for presence of cervical HPV: systematic review and meta-analysis. BMJ 2014;349:g5264.