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HPV testing in primary cervical screening: a systematic review and meta-analysis
Joan Murphy1, Erin B Kennedy2, Sheila Dunn3
1Division of Gynecologic Oncology, University Health Network, Toronto ON.
Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|May 5, 2012
Summary
Human papillomavirus (HPV) testing detects more cervical intraepithelial neoplasia (CIN3+) initially but less in subsequent rounds compared to cytology. HPV testing is recommended for primary cervical screening in women aged 30 and older.
Area of Science:
- Gynecology
- Oncology
- Public Health
Background:
- Cross-sectional studies indicate human papillomavirus (HPV) testing surpasses cytology in sensitivity for primary cervical screening.
- The impact of HPV testing's increased baseline detection on subsequent screening round outcomes remains under investigation.
Purpose of the Study:
- To systematically review randomized controlled trials comparing HPV-based and cytology-based cervical screening.
- To assess if higher initial detection rates with HPV testing correlate with reduced rates in later screening rounds.
Main Methods:
- Systematic review of randomized controlled trials (2005-2010) comparing HPV and cytology cervical screening.
- Primary outcomes: relative rates of cervical intraepithelial neoplasia (CIN3+) and invasive cervical cancer.
- Secondary outcomes: test performance and colposcopy referral rates; meta-analysis using random effects model.
Main Results:
- HPV testing detected significantly more CIN3+ in the first round (RR 1.67) but significantly less in the second round (RR 0.49).
- Pooled rates for CIN2+ and CIN3+ showed no significant difference over two rounds, though CIN2 rates were higher with HPV testing (RR 1.37).
- A trend towards reduced invasive cervical cancer rates was observed with HPV testing.
Conclusions:
- Organized cervical screening programs in high-resource settings should consider HPV testing for women aged 30/35+.
- Further research is necessary to establish optimal HPV screening strategies for younger women.
