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Primary HPV screening for cervical cancer prevention: results from European trials

Nature Reviews Clinical Oncology volume 6, pages 699–706 (2009)Cite this article

Abstract

Six European, randomized, controlled trials that will compare human papillomavirus (HPV) testing with cytological testing for cervical screening are under way. We reviewed the results published so far to compare the benefits and costs for participating women. At baseline screening, use of HPV testing increased the detection of cervical intraepithelial neoplasia (CIN) grade 2+. Detection of CIN3+ was significantly increased in two trials (relative risks [RRs] 1.70 and 2.26), but not in three other trials (RRs 1.03, 1.09 and 1.31). In three trials, seven extra women had a false-positive test for each extra detected CIN2+ case; although, in another trial, this number was 49 in women ≥35 years of age. The outcome of HPV testing versus cytological testing depends not only on the relative accuracy of the primary test but also on how radical the different triage procedures are. In two trials with published outcomes from the subsequent screening round, an approximately 50% reduction in CIN3+ detection was evident in the subsequent screening. However, in these two trials the screening modalities changed between the baseline and subsequent screening rounds, so these data do not show the effect of a switch from primary screening with cytological testing to primary screening with HPV testing.

Key Points

  • In trials undertaken within European, well-established, population-based, organized screening programs, use of HPV testing compared with cytological testing increased the detection rate of CIN2+ by about 50%

  • The detection rate of CIN3+ was significantly increased in only two of five trials

  • For each extra detected CIN2+ case, about seven extra women had a false-positive screening test, although in one trial this number was 49 in women aged 35 years or older

  • A 50% reduction in CIN3+ detection at the subsequent screening of two studies is not the result of a change of primary screening from cytology only to HPV testing only

  • The key public health challenge is now to find the optimum triage procedure for women who test positive for HPV at primary screening

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Acknowledgements

The authors would like to thank Sisse Helle Njor and Kristine Bihrmann for their statistical advice.

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  1. Institute of Public Health, University of Copenhagen, Denmark

    Elsebeth Lynge & Matejka Rebolj

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  1. Elsebeth Lynge
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Correspondence to Elsebeth Lynge.

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The authors declare no competing financial interests.

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Lynge, E., Rebolj, M. Primary HPV screening for cervical cancer prevention: results from European trials. Nat Rev Clin Oncol 6, 699–706 (2009). https://doi.org/10.1038/nrclinonc.2009.167

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