HPV-based screening better prevents invasive cervical cancer vs. cytology

Key takeaways:

• HPV-based vs. cytology-based screening was tied to lower risks for invasive cervical cancer.
• Adverse events were more common for HPV-based screening vs. cytology-based screening.

HPV-based screening was superior to cytology in preventing invasive cervical cancer in real-world settings in Sweden, according to a randomized trial published in Lancet Public Health.

“International guidelines recommend that cervical screening should be performed using primary testing for HPV DNA. These recommendations are based on a series of randomized clinical trials that have found HPV DNA testing to have a better protection against invasive cervical cancer compared with the previously used screening method,” Jiangrong Wang, PhD, a postdoctoral researcher in the department of clinical science, intervention and technology at the Center for Cervical Cancer Elimination at Karolinska Institutet in Stockholm, and colleagues wrote. “Cervical screening has switched to HPV-based screening in many countries, but there are still countries that use cytology as a primary method for screening.”

Wang and colleagues analyzed data from 395,319 women aged 30 to 64 years eligible for HPV-based or cytology-based screening between 2014 and 2016 in the capital region of Sweden. All women were randomly assigned to HPV- (n = 212,199) or cytology-based (n = 183,120) screening and researchers compared invasive cervical cancer incidence during 8 years of follow up.

At second screening, attendance was higher for women in the HPV-based vs. cytology-based screening groups (48.4% vs. 47.7%).

Women invited to the HPV-based screening group demonstrated a 17% lower risk for invasive cervical cancer vs. women invited to the cytology-based group (HR = 0.83; 95% CI, 0.7-0.98). Those who participated in HPV-based screening had a 28% lower risk for invasive cervical cancer compared with those participating in cytology-based screening (HR = 0.72; 95% CI, 0.54-0.95).

Risk for invasive cervical cancer per 100,000 person-years was 1.3 for women who were HPV-negative at baseline compared with 9.1 for women with normal cytology (HR = 0.14; 95% CI, 0.07-0.28). Women who were HPV-positive with negative cytology had invasive cervical cancer risks of 79.2 and those who were HPV 16 or 18-positive with negative cytology had risks of 318.2.

In both the intention-to-screen and per-protocol analyses, adverse events were higher for HPV-based vs cytology-based screening (7.5% vs. 6.9% and 9% vs. 7.9%, respectively).

“The findings of previous randomized clinical trials and this large randomized cervical screening policy support the global implementation of HPV-based cervical screening and highlight a need for future research to improve triaging of women who test positive for HPV at screening,” the researchers wrote.