Is detection of high-grade cervical neoplasia superior with co-testing or with primary HPV testing only?
The results of this population-based retrospective Swedish cohort support HPV testing alone as a routine screening approach for cervical cancer. Among individuals confirmed by biopsy to have CIN2+, cytology was positive in < 0.02% of individuals with negative HPV. These results didn’t hold for testing based on clinical indications or for unknown indication, in which 3.8% of individuals with CIN2+ would have been missed without cytology as a co-test.
This is a large retrospective population-based cohort study (N = 208,701) using Swedish registry data to assess cervical cancer screening outcomes with human papillomavirus (HPV) testing alone versus co-testing with HPV testing and cytology (usually Thin Prep). The authors included individuals aged 40 to 42 years in 2019 who had cervical cancer testing (n = 18,674), of which the population of interest was 10,643 (with 10,664 tests) who were part of the Swedish cervical screening program. The rest of the testing was for clinical indications (n = 4529) or unknown (n = 3481). In the vast majority of cases, co-testing was on the same day (99.6%). Co-tests outside the 14-day window were excluded. There were 197 individuals who had biopsy within 6 months of co-testing with results of cervical intraepithelial neoplasia grade 2, grade 3, or cancer (CIN2+). Of these, 189 had both positive cytology and positive HPV, 6 had negative cytology with positive HPV, and 2 (< 0.02%) had positive cytology with negative HPV. CIN2+ with results showing positive cytology and negative HPV was more common among individuals who were tested for clinical or unknown indications (11/290; 3.8%). The prevalence of HPV vaccination in the population studied was not provided.
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo