TOMBOLA trial throws doubts on the value of HPV triage
Numerous studies have shown that HPV testing is good at detecting abnormalities in women with low-grade tests and can reduce the number who need to be referred for treatment, especially in the over 35s. However, a recent publication in BJOG seems to cast doubt over the presumed benefits of HPV testing as a means of triage for low grade cytological abnormalities.
In the study 4439 women with borderline changes or mild dyskaryosis received an HPV test and were followed for three years. Outcome was determined by an exit colposcopy examination. Across all ages, 22% of women who had CIN2 or worse were HPV negative. Conversely, 40% of those who were HPV positive did not have CIN. The authors conclude: "...in younger women with low-grade cytological abnormalities, a single HPV test would not be useful in determining who should be referred for colposcopy or the most effective management at colposcopy. In women over 40, a negative HPV test could be used to rule out further investigation."