Urinary HPV Testing May Be an Alternative to Pap Smear

The current standard of cervical cancer screening in France is cytological examination of a Pap smear, but collection is considered invasive and burdensome for some women. Investigators with University Hospital Center of Angers wanted to determine whether a urine test for human papillomavirus (HPV) would increase compliance rates.

The research team presented findings from the CapU3 study in an oral session at the European Congress for Clinical Microbiology and Infectious Diseases (ECCMID 2019).

In collaboration with the cancer screening coordination center of Pays de la Loire, investigators offered urinary HPV testing to 13,535 women aged 35 to 65 who had not had a Pap smear in the last 7 years.

The urinary test for HPV involves a real-time polymerase chain reaction technique (Anyplex II HPV28 Detection) that can detect 28 genotypes (19 high-risk HPV and 9 low-risk HPV). Patients who receive a positive test are encouraged to follow up with a Pap smear, while women who test negative are advised to undergo a Pap smear within 1 year.

After accounting for exclusion, 1781 samples were ultimately analyzed in the trial (participation rate 14.5%). A total of 1576 were negative for at least 1 high-risk HPV strain, while 183 samples tested positive. Twenty-two samples returned invalid results. Among the patients with abnormal follow-up cervical smears, 4 cervical intraepithelial neoplasia grade 3, and 6 grade 1 lesions were detected after colposcopies with biopsies.

Investigators concluded that urinary HPV testing may be a good alternative to undergoing a Pap smear.

“Because home HPV urinary testing is non-invasive and do[es] not require medical attention, this method may be an alternative for women who are reluctant to use Pap smear,” the investigators wrote. “Furthermore, 72.0% of the HPV-positive women included in the CapU3 study benefited from a Pap smear collected by a clinician during follow-up. So, the urinary HPV test could be an alternative to the usual screening by cervical smear thus extending screening coverage in our department.”

The study, “Urinary HPV DNA testing as a tool for cervical cancer screening in France: CapU3 study,” was presented in an oral session on Saturday, April 13, 2019, at ECCMID 2019 in Amsterdam, the Netherlands.