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Human papillomavirus testing with conventional Pap smear screening in three inner London community clinics
  1. Amanda Herbert, MBBS, FRCPath, Consultant1,
  2. Parmjit Chana, MSc, FIMBS, Biomedical Scientist1,
  3. Giuseppe Culora, MBBS, FRCPath, Consultant1,
  4. Jennifer M Best, PhD, FRCPath, Emeritus Reader in Virology2,
  5. Elena Ktori, MSc, Biomedical Scientist3,
  6. Ali A Kubba, MBBS, FRCOG, Consultant4,
  7. Margaret Nowicki, MBBS, MFFP, Associate Specialist4,
  8. Hilda Dunsmore, MBBS, Associate Specialist5 and
  9. Marc Arbyn, MD, MSc, Consultant6
  1. Histopathology Department, St Thomas' Hospital, London, UK
  2. Department of Infectious Diseases, King's College School of Medicine, London, UK
  3. Department of Infection, St Thomas' Hospital, London, UK
  4. Department of Reproductive and Sexual Health, Lambeth Primary Care Trust, Mawbey Brough Health Centre, London, UK
  5. Colposcopy Unit, McNair Centre, Guy's Hospital, London, UK
  6. Scientific Institute of Public Health, Brussels, Belgium and European Cancer Network, IARC, Lyon, France
  1. Correspondence to Dr Amanda Herbert, Department of Histopathology, Second Floor, North Wing, St Thomas' Hospital, London SE1 7EH, UK. E-mail: amanda.herbert{at}


Background and methodology This observational study aimed to establish prevalence of high-risk human papillomaviruses (hrHPV) in women attending three inner London community clinics for routine screening and to pilot hrHPV testing in the triage of either borderline or negative cytology after previous abnormalities. Hybrid Capture® 2 was carried out on brush samples taken alongside conventional smears from 1434 women aged 20–49 years. hrHPV positivity prompted earlier referral of women with previous abnormalities and either low-grade or negative cytology. Outcome at colposcopy was compared with the records of 1871 women aged 20–49 years attending colposcopy during the same period of time (routine colposcopies).

Results hrHPV was detected in 111/161 (68.9%) women with abnormal cytology, 76/460 (16.5%) with negative cytology after previous abnormalities and 105/813 (12.9%) with negative cytology and no previous abnormalities. Overall, hrHPV was detected in 292/1434 (20.4%) women in the study (95% CI 18.3–22.5). hrHPV prevalence increased with severity of cytological abnormality (p<0.001) and decreased with age both with negative and low-grade cytology (p<0.001). High-grade cervical intraepithelial neoplasia (CIN) biopsies were found more frequently in women in the study groups with low-grade (p<0.001) or negative cytology than in routine colposcopies, but more women in the study groups attended colposcopy (8.2% compared with 4.1% routine colposcopies, p<0.001).

Conclusions hrHPV positivity increased detection of high-grade CIN in the study groups at the expense of more colposcopies. hrHPV negativity could reduce the need for investigation of low-grade cytology in women aged over 35 years and for surveillance after previous abnormalities.

  • colposcopy
  • cytological surveillance
  • human papillomavirus testing
  • low-grade cytology triage

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