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Randomized Implementation of a Primary Human Papillomavirus Testing-based Cervical Cancer Screening Protocol for
Mari Nygård1, Birgit Engesæter1, Philip E Castle2,3
1The Cancer Registry of Norway, Oslo, Norway.
Summary
Human papillomavirus (HPV) screening is more effective than liquid-based cytology for detecting cervical intraepithelial neoplasia and cancer. This study demonstrates HPV testing
Area of Science:
- Gynecology
- Oncology
- Public Health
Background:
- Cervical cancer screening is transitioning from liquid-based cytology (LBC) to human papillomavirus (HPV) testing.
- A randomized study in Norway compared the real-world effectiveness of HPV-Screening protocol versus LBC-Screening protocol.
- This transition aims for a safe and quality-assured implementation of new screening technologies.
Purpose of the Study:
- To compare the effectiveness of HPV-Screening protocol and LBC-Screening protocol in a real-world setting.
- To evaluate the safety and feasibility of transitioning to HPV-based cervical cancer screening nationwide.
Main Methods:
- A randomized trial involving 157,447 women aged 34-69 years.
- Participants were allocated to either HPV-Screening protocol (77,207) or LBC-Screening protocol (80,240).
- Follow-up was conducted for 18 months post-screening.
Main Results:
- HPV-Screening protocol detected significantly more cervical intraepithelial neoplasia (CIN) grade 2 or worse (60% increase) and CIN grade 3 or worse (40% increase) compared to LBC.
- Cancer detection rates were 40% higher with HPV-Screening protocol.
- HPV-Screening protocol led to a 60% increase in colposcopy referrals and was more effective in women under 50.
Conclusions:
- The HPV-Screening protocol demonstrated superior effectiveness in detecting precancerous lesions and cancer compared to LBC.
- The protocol was well-accepted by women in Norway.
- Randomized implementation facilitated a safe technology transition for nationwide screening.
