HPV-based screening can replace cytology-based screening for cervical cancer

Reference

Elfström KM, Eklund C, Lamin H, et al. Organized primary human papillomavirus-based cervical screening: A randomized healthcare policy trial. PLoS Med 2021;18(8):e1003748.

Synopsis

These investigators invited almost 400,000 women aged 30 to 64 years (average age 45 years) to every-three-year cervical cancer screening; slightly more than half the women participated. The women were randomized* to receive either cytology-based screening with a human papillomavirus (HPV)–based screening follow-up of abnormal results (atypical squamous cells of undetermined significance [ASCUS] or worse) or to HPV-based screening with cytology follow-up of women with positive results. Biopsy was performed for abnormal cytology results or positive HPV results when repeated in three years. Of women who had participated in the organized screening program, 8.81% of women who received HPV screening had a positive result, but only 2.26% were referred for biopsy following cytology. Similarly, in the cytology-first arm, 3.25% (95% CI 3.14 - 3.37) of women had an abnormal screen result, but only 1.83% were referred for biopsy after HPV triage of low-grade cytology. Overall, cervical intraepithelial neoplasia grade 2 (CIN2) detection rates were slightly higher (odds ratio: 1.11; 1.02 - 1.22) and referral rates for biopsy were about 10% higher with the HPV-first approach. *The randomization process was a bit of an issue, resulting in more women being invited to and enrolled in HPV-first screening, especially among women older than 50 years, which could have skewed the results to favor HPV screening.