Primary cervical screening with high risk human papillomavirus testing: observational study

Matejka Rebolj*, Janet Rimmer, Karin Denton, John Tidy, Christopher Mathews, Kay Ellis, John Smith, Chris Evans, Thomas Giles, Viki Frew, Xenia Tyler, Alexandra Sargent, Janet Parker, Miles Holbrook, Katherine Hunt, Penny Tidbury, Tanya Levine, David Smith, Julietta Patnick, Ruth StubbsSue Moss, Henry Kitchener

*Corresponding author for this work

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119 Citations (Scopus)
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Abstract

OBJECTIVE: To provide the first report on the main outcomes from the prevalence and incidence rounds of a large pilot of routine primary high risk human papillomavirus (hrHPV) testing in England, compared with contemporaneous primary liquid based cytology screening.

DESIGN: Observational study.

SETTING: The English Cervical Screening Programme.

PARTICIPANTS: 578 547 women undergoing cervical screening in primary care between May 2013 and December 2014, with follow-up until May 2017; 183 970 (32%) were screened with hrHPV testing.

INTERVENTIONS: Routine cervical screening with hrHPV testing with liquid based cytology triage and two early recalls for women who were hrHPV positive and cytology negative, following the national screening age and interval recommendations.

MAIN OUTCOME MEASURES: Frequency of referral for a colposcopy; adherence to early recall; and relative detection of cervical intraepithelial neoplasia grade 2 or worse from hrHPV testing compared with liquid based cytology in two consecutive screening rounds.

RESULTS: Baseline hrHPV testing and early recall required approximately 80% more colposcopies, (adjusted odds ratio 1.77, 95% confidence interval 1.73 to 1.82), but detected substantially more cervical intraepithelial neoplasia than liquid based cytology (1.49 for cervical intraepithelial neoplasia grade 2 or worse, 1.43 to 1.55; 1.44 for cervical intraepithelial neoplasia grade 3 or worse, 1.36 to 1.51) and for cervical cancer (1.27, 0.99 to 1.63). Attendance at early recall and colposcopy referral were 80% and 95%, respectively. At the incidence screen, the 33 506 women screened with hrHPV testing had substantially less cervical intraepithelial neoplasia grade 3 or worse than the 77 017 women screened with liquid based cytology (0.14, 0.09 to 0.23).

CONCLUSIONS: In England, routine primary hrHPV screening increased the detection of cervical intraepithelial neoplasia grade 3 or worse and cervical cancer by approximately 40% and 30%, respectively, compared with liquid based cytology. The very low incidence of cervical intraepithelial neoplasia grade 3 or worse after three years supports extending the screening interval.

Original languageEnglish
Article number1240
Number of pages10
JournalBMJ (Online)
Volume364
Issue number1-9
Early online date6 Feb 2019
DOIs
Publication statusPublished - 6 Feb 2019

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