Screening with a primary human papillomavirus test does not increase detection of cervical cancer and intraepithelial neoplasia 3.
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.
Kotaniemi-Talonen
Laura
L
Mass Screening Registry, Finnish Cancer Registry, Liisankatu 21 B, FI-00170 Helsinki, Finland. laura.kotaniemi-talonen@cancer.fi
Anttila
Ahti
A
Malila
Nea
N
Tarkkanen
Jussi
J
Laurila
Pekka
P
Hakama
Matti
M
Nieminen
Pekka
P
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
D004279:DNA, Viral