title: HPV testing in routine cervical screening: cross sectional data from the ARTISTIC trial.
abstract: To evaluate the effectiveness of human papillomavirus (HPV) testing in primary cervical screening. This was a cross-sectional study from the recruitment phase of a prospective randomised trial. Women were screened for HPV in addition to routine cervical cytology testing. Greater Manchester, attendees at routine NHS Cervical Screening Programme. In all, 24 510 women aged 20-64 screened with liquid-based cytology (LBC) and HPV testing at entry. HPV testing in primary cervical screening. Type-specific HPV prevalence rates are presented in relation to age as well as cytological and histological findings at entry. In all, 24 510 women had adequate cytology and HPV results. Cytology results at entry were: 87% normal, 11% borderline or mild, 1.1% moderate and 0.6% severe dyskaryosis or worse. Prevalence of HPV decreased sharply with age, from 40% at age 20-24 to 12% at 35-39 and 7% or less above age 50. It increased with cytological grade, from 10% of normal cytology and 31% of borderline to 70% mild, 86% moderate, and 96% of severe dyskaryosis or worse. HPV 16 or HPV 18 accounted for 64% of infections in women with severe or worse cytology, and one or both were found in 61% of women with severe dyskaryosis but in only 2.2% of those with normal cytology. The majority of young women in Greater Manchester have been infected with a high-risk HPV by the age of 30. HPV testing is practicable as a primary routine screening test, but in women aged under 30 years, this would lead to a substantial increase in retesting and referral rates. HPV 16 and HPV 18 are more predictive of underlying disease, but other HPV types account for 30% of high-grade disease.
authors.affiliation: Division of Human Development, University of Manchester, Hathersage Road, Manchester M13 0JH, UK. henry.kitchener@cmmc.nhs.uk
authors.forename: H C
authors.initials: HC
authors.lastname: Kitchener
authors.forename: M
authors.initials: M
authors.lastname: Almonte
authors.forename: P
authors.initials: P
authors.lastname: Wheeler
authors.forename: M
authors.initials: M
authors.lastname: Desai
authors.forename: C
authors.initials: C
authors.lastname: Gilham
authors.forename: A
authors.initials: A
authors.lastname: Bailey
authors.forename: A
authors.initials: A
authors.lastname: Sargent
authors.forename: J
authors.initials: J
authors.lastname: Peto
mesh_terms: D000328:Adult; D017677:Age Distribution; D003430:Cross-Sectional Studies; D003584:Cytological Techniques / Q000379:methods; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D006113:United Kingdom / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology*; D014626:Vaginal Smears / Q000379:methods*