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 In a study comparing the accuracy of urine sample testing with smear
testing conducted by a doctor, scientists from Britain and Spain
found the results were good and said using the urine test to detect
human papillomavirus (HPV) could lead to more women agreeing to be
screened.
"The detection of HPV in urine is non-invasive, easily accessible
and acceptable to women, and a test with these qualities could
considerably increase uptake," the researchers said on Tuesday in
thebmj.com, the online version of the British Medical Journal.
The study, which analyzed 14 studies involving 1,443 sexually active
women, was led by Neha Pathak of the women's health research unit at
Queen Mary University of London.
Compared with cervical smear samples, urine HPV testing had an
overall sensitivity -- the proportion of positives correctly
identified -- of 87 percent, and a specificity -- the proportion of
negatives correctly identified -- of 94 percent.
Urine testing for the particularly high risk strains of HPV that
cause the majority of cervical cancer cases, had an overall
sensitivity of 73 percent and a specificity of 98 percent compared
with cervical samples.
HPV is one of the most common sexually transmitted infections, with
up to 80 percent of sexually active women infected at some point in
their lives.
Infection with specific high risk strains of HPV can cause cervical
cancer, which kills around 266,000 women a year globally, according
to the World Health Organization.
By the far the vast majority of cervical cancer deaths are in poorer
countries where access to screening and prevention methods is less
widely available.
In a smear test, an instrument called a speculum is inserted into
the vagina to allow access to the cervix and a brush is used to
collect cells from the surface of the cervix.
In wealthier developed countries, cervical screening for HPV has
been in place for many years and have been able to catch many
potential cancer cases before they develop.
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More recently, national immunization programs using vaccines from
drugmakers Merck and GlaxoSmithKline have been launched to protect
girls from HPV.
Yet in developing nations, where some 445,000 cases were diagnosed
and 230,000 women died of cervical cancer in 2012, infrastructures
have not yet been established to run national screening programs and
HPV vaccination is still rare.
In a commentary on Pathak's study, Henry Kitchener, professor and
chair of gynecological oncology at Manchester University noted that
even in developed countries such as Britain, for example, cervical
screening coverage has fallen below 80 percent in recent years.
This is partly due to some complacency about cervical cancer as it
starts to be come less common, he said, but also partly due to
emotional factors such as embarrassment or fear of an invasive
speculum examination.
Using a urine test instead of a smear could persuade those reluctant
women to come for regular screening, Kitchener said, while in lower
income countries that lack infrastructure "self sampling (urine
testing) might even be beneficial and cost effective for all women
who are eligible for screening".
(Editing by Jeremy Gaunt)
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