title: Randomized evaluation trial on automation-assisted screening for cervical cancer: results after 777,000 invitations.
abstract: OBJECTIVE
  New cervical screening methods have been developed. They seem to become accepted in routine use without randomized trials, within existing screening programmes. Our aim was to evaluate, in a randomized setting, the performance of automation-assisted cytological screening in routine use compared with conventional Papanicoalou (Pap) screening.
  
  
  METHODS
  This prospective study was based on a 1:2 individually randomized design. Altogether 777,144 women were invited to attend the routine screening programme.
  
  
  RESULTS
  Automation-assisted screening found more Pap class III (LSIL+) findings compared with conventional study arm, relative risk (RR) 1.08 (confidence interval 1.01-1.15). Also, detection rates of verified pre-cancers were more common in automation-assisted arm, RR 1.11 (1.02-1.21).
  
  
  CONCLUSIONS
  Automation-assisted screening performed well compared with conventional screening. The difference was smaller than reported in non-randomized studies. A new technique may assume several years to reach the ultimate quality and can add costs without improving efficacy. Follow-up of prevented cervical cancers is required.
authors.affiliation: Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Box 140, FIN-00029, Helsinki, Finland. pekka.nieminen@hus.fi
authors.forename: Pekka
authors.initials: P
authors.lastname: Nieminen
authors.forename: Laura
authors.initials: L
authors.lastname: Kotaniemi-Talonen
authors.forename: Matti
authors.initials: M
authors.lastname: Hakama
authors.forename: Jussi
authors.initials: J
authors.lastname: Tarkkanen
authors.forename: Jorma
authors.initials: J
authors.lastname: Martikainen
authors.forename: Terttu
authors.initials: T
authors.lastname: Toivonen
authors.forename: Jorma
authors.initials: J
authors.lastname: Ikkala
authors.forename: Ahti
authors.initials: A
authors.lastname: Anttila
mesh_terms: D000328:Adult; D000368:Aged; D001331:Automation; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*