title: Screening with a primary human papillomavirus test does not increase detection of cervical cancer and intraepithelial neoplasia 3.
abstract: OBJECTIVE
  To determine cross-sectional validity of primary human papillomavirus (HPV) screening in comparison to cytological screening.
  
  
  METHODS
  During 2003-2004, 61,149 women were individually randomised to screening with a test for oncogenic HPV DNA or to conventional cytological screening within the Finnish cervical screening programme.
  
  
  RESULTS
  For HPV screening, cross-sectional relative sensitivity for cervical intraepithelial neoplasia (CIN) or cancer was 1.58 (95 % confidence interval 1.19-2.09) in comparison to cytology. At the level of CIN 3 or cancer no increase in relative sensitivity was observed. Cross-sectional specificity estimates for the screening arms were comparable, but the specificity of screening with sole HPV DNA test was clearly inferior.
  
  
  CONCLUSIONS
  Primary HPV screening with cytology triage finds more CIN lesions compared to conventional screening but mild lesions are overrepresented. This is likely to result in overdiagnosis since most mild lesions are regressive.
authors.affiliation: Mass Screening Registry, Finnish Cancer Registry, Liisankatu 21 B, FI-00170 Helsinki, Finland. laura.kotaniemi-talonen@cancer.fi
authors.forename: Laura
authors.initials: L
authors.lastname: Kotaniemi-Talonen
authors.forename: Ahti
authors.initials: A
authors.lastname: Anttila
authors.forename: Nea
authors.initials: N
authors.lastname: Malila
authors.forename: Jussi
authors.initials: J
authors.lastname: Tarkkanen
authors.forename: Pekka
authors.initials: P
authors.lastname: Laurila
authors.forename: Matti
authors.initials: M
authors.lastname: Hakama
authors.forename: Pekka
authors.initials: P
authors.lastname: Nieminen
mesh_terms: D000328:Adult; D000368:Aged; D052685:Alphapapillomavirus / Q000302:isolation & purification; D003127:Colposcopy / Q000379:methods; D003430:Cross-Sectional Studies; D003584:Cytological Techniques / Q000379:methods / Q000592:standards; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D014626:Vaginal Smears / Q000379:methods; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000821:virology
chemical_list: D004279:DNA, Viral