The pilot of routine primary high-risk human papillomavirus (hrHPV) testing in England has demonstrated that the approach works well in practice and is more sensitive than liquid-based cytology (LBC). The results of the pilot, published in the BMJ, support the national roll-out of hrHPV testing.
In the pilot programme, 578,547 women aged 24-64 years underwent routine cervical screening (hrHPV, 32%; LBC, 68%) between May 2013 and December 2014, who were followed up until May 2017. Women were immediately referred for colposcopy if their hrHPV test was positive or cervical lesions were found.
hrHPV positive women with no cervical lesions were asked to return in 12 months for another test (early recall), and if hrHPV persisted without abnormal cells, were recalled again at 24 months.
The researchers found that hrHPV screening detected substantially more cervical intraepithelial neoplasia (CIN) than LBC testing (50% more CIN grade 2 (CIN2+), 40% more CIN3+ and 30% more cervical cancer. A quarter of CIN2+ cases were detected after early recall in women with no cervical lesions.
In addition, this increased detection in prevalence was followed by a marked reduction in the incidence of new cases after 3 years, "lending strong support to an extension of the screening intervals," the authors conclude.