HPV testing better than cytology for women vaccinated against HPV

Référence

Canfell K, Caruana M, Gebski V, et al. Cervical screening with primary HPV testing or cytology in a population of women in which those aged 33 years or younger had previously been offered HPV vaccination: Results of the Compass pilot randomised trial. PLoS Med 2017;14(9): e1002388.

Sommaire

In Australia, where this study was performed, all women included in this aspect of the study had been offered HPV vaccination, either at age 12 or 13 years or later as a catch-up, with an estimated 50% to 77% of women receiving all 3 doses. In this study 1078 women younger than 33 years who had been offered HPV vaccine were randomized, using concealed allocation, to cervical cancer screening using 1 of 3 strategies: (1) liquid-based cytology (ThinPrep) every 2.5 years with follow-up HPV co-testing if the results were abnormal; (2) HPV testing every 5 years with follow-up cytology or colposcopy if the results were abnormal; or (3) HPV testing every 5 years with follow-up cell staining for oncogenic markers in women with identified oncogenic HPV (HPV 16 or 18) on initial screen (further details of follow-up testing and confirmation can be found here: https://goo.gl/J3MX4V). Rates of identification of high-grade precancerous disease (CIN2+) were higher in women in each HPV testing arm (2.6% and 2.9%) than with cytology (0.5%; P = .05). Unfortunately, the researchers don't know the percentage of eligible women who received the vaccine, and most of the women had been screened at some point before the study was started, biasing the sample toward lower rates of disease.