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Urine HPV Test Could Offer Alternative to Conventional Smear

U.K. researchers develop self-sampling test

A simple urine test for human papillomavirus (HPV) could offer a more acceptable, noninvasive alternative to the conventional cervical test and could improve screening uptake, researchers at Queen Mary University of London have found.

HPV infection is one of the most common sexually transmitted diseases. Up to 80% of sexually active women are infected at some point in their lives, and infection with specific “high risk” strains of HPV has been linked to cervical cancer.

Several studies have suggested that detecting HPV in urine may be a feasible alternative to cervical sampling, but the accuracy of such a test is still uncertain.

In a study published online in the British Medical Journal, a team of researchers based in London and Spain analyzed the results of 14 studies involving a total of 1,443 sexually active women to determine the accuracy of testing for HPV in urine samples compared with cervical samples obtained by a doctor.

Compared with cervical samples, urine HPV testing had an overall sensitivity of 87% (the proportion of positives correctly identified) and a specificity of 94% (the proportion of negatives correctly identified). Urine testing for high-risk HPV types 16 and 18 (the types that cause most cases of cervical cancer) had an overall sensitivity of 73% and a specificity of 98% compared with cervical samples.

The accuracy of the urine test increased when first-void samples were collected (the first urine of the day) compared with random or mid-stream samples, probably because first-void urine samples contain higher levels of DNA.

“The detection of HPV in urine is noninvasive, easily accessible, and acceptable to women, and a test with these qualities could considerably increase uptake,” the authors say.

They stress that their results should be interpreted with caution “due to variation between individual studies,” but they say that when HPV testing is considered for cervical cancer screening, “urine-based testing should be considered as an accurate and acceptable alternative that could increase screening coverage.”

In an accompanying editorial, researchers at the University of Manchester say urine testing for HPV is a promising screening option that deserves further evaluation.

They suggest that self-sampling “could be used for women who are reluctant to attend for regular cervical screening.” In addition, in lower-income countries that lack infrastructure, “self-sampling might even be beneficial and cost-effective for all women who are eligible for screening.”

Source: Queen Mary University of London; September 17, 2014.

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