title: A comparison of HPV DNA testing and liquid based cytology over three rounds of primary cervical screening: extended follow up in the ARTISTIC trial.
abstract: BACKGROUND
  The additional sensitivity of HPV testing compared with cytology could permit extended cervical screening intervals. We wished to determine, through a further (third) round of screening in the ARTISTIC trial, the protection provided by a negative baseline HPV screen compared with that of cytology over a 6 year period.
  
  
  METHODS
  Cumulative rates of CIN2 or worse (CIN2+) and CIN3 or worse (CIN3+) were correlated with baseline HPV status and cytology. HPV was detected using the Hybrid Capture 2 (Qiagen) assay for high risk types and genotyped using the Linear Array (Roche) and Papillocheck (Greiner) assays. LBC was performed using ThinPrep (Hologic).
  
  
  RESULTS
  Round 3 included 8,873 women of whom 6,337 had been screened in both rounds 1 and 2 and 2,536 had not been screened since round 1. The median duration of follow-up was 72.7 months. The cumulative rate of CIN2+ over three rounds was 3.88% (95%CI 3.59%, 4.17%) overall; 2.39% in round 1, 0.78% in round 2 and 0.74% in round 3. Cumulative rates by baseline status were 20.53% (95%CI 19.04%, 22.08%) for abnormal cytology, 20.12% (95%CI 18.68%, 21.61%) for HPV detection, 1.41% (95%CI 1.19%, 1.65%) for negative cytology and 0.87% (95%CI 0.70%, 1.06%) for a negative HPV test. In HPV negative women aged over 50 the cumulative rate was 0.16% (95%CI 0.07%, 0.34%). Women who were HPV positive/cytology negative at entry had a cumulative CIN2+ rate of 7.73% (95%CI 6.29%, 9.36%) over 6 years, twice the overall rate.
  
  
  CONCLUSIONS
  A negative HPV test was significantly more protective than normal cytology over three rounds. The findings of this extension of ARTISTIC suggest that the screening interval could be extended to 6 years if HPV testing replaced cytology as the primary screening test.
authors.affiliation: School of Cancer and Enabling Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. Henry.c.kitchener@manchester.ac.uk
authors.forename: Henry C
authors.initials: HC
authors.lastname: Kitchener
authors.forename: Clare
authors.initials: C
authors.lastname: Gilham
authors.forename: Alexandra
authors.initials: A
authors.lastname: Sargent
authors.forename: Andrew
authors.initials: A
authors.lastname: Bailey
authors.forename: Rebecca
authors.initials: R
authors.lastname: Albrow
authors.forename: Christopher
authors.initials: C
authors.lastname: Roberts
authors.forename: Mina
authors.initials: M
authors.lastname: Desai
authors.forename: Jean
authors.initials: J
authors.lastname: Mather
authors.forename: Andrew
authors.initials: A
authors.lastname: Turner
authors.forename: Sue
authors.initials: S
authors.lastname: Moss
authors.forename: Julian
authors.initials: J
authors.lastname: Peto
mesh_terms: D000328:Adult; D052685:Alphapapillomavirus / Q000235:genetics*; D004279:DNA, Viral / Q000032:analysis*; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D005820:Genetic Testing / Q000379:methods; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000379:methods; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*
chemical_list: D004279:DNA, Viral