Clinical Question

Is screening for human papillomavirus (HPV) an effective approach to identifying women at low risk of cervical cancer?

Bottom Line

A single HPV test provides the same degree of protection over five years as a Papanicolaou (Pap) smear does for three years. We may soon see a recommendation for HPV testing as a stand-alone screen, with cytology reserved for women who have an HPV-positive result. We may also be able to extend the screening interval to at least five years. (Level of Evidence = 1b)

Synopsis

This analysis comes from the Swedescreen randomized controlled trial, which invited women 32 to 38 years of age from 1997 to 2000 to be screened for HPV while also being screened for cervical cancer using standard cytology. Of the 12,091 women enrolled, 387 (3.2%) developed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and 230 (1.9%) developed grade 3 or worse (CIN3+) over a median 11 years of follow-up. HPV screening every five years had a sensitivity (across both arms of the study) of 89% to 92% and a specificity of 91% to 94% for CIN3+. These numbers are similar to cytology screening results at three years (sensitivity = 77% to 92%; specificity = 98%). The combination of cytology and HPV screening increased sensitivity slightly at five years (92% to 96%). Women with a positive HPV screening result were not at an increased likelihood of being diagnosed with CIN2+ or CIN3+ compared with cytology screening, making the risk of overdiagnosis low.

Study design: Cohort (prospective)

Funding source: Foundation

Setting: Population-based

Reference: ElfströmKMSmelovVJohanssonALet alLong term duration of protective effect for HPV negative women: follow-up of primary HPV screening randomised controlled trial. BMJ.2014; 348: g130.