title: HPV testing in primary cervical screening: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Previous findings from cross-sectional studies have shown human papillomavirus (HPV) testing to be more sensitive than cytology testing for primary cervical screening. This systematic review aims to assess whether the increase in baseline detection with HPV testing corresponds to lower rates in subsequent screening rounds.
  
  
  METHODS
  We searched Medline, EMBASE, and the Cochrane Library for randomized controlled trials (published from 2005 to 2010) comparing HPV-based and cytology-based cervical screening. Primary outcomes of interest were relative rates of higher grade cervical intraepithelial neoplasia and invasive cervical cancer. Secondary outcomes included test performance characteristics and colposcopy referral rates. Results were pooled where possible using a random effects model.
  
  
  RESULTS
  Seven randomized trials were identified. Across studies, HPV testing was more accurate than conventional cytology and detected significantly more CIN3+ in the first screening round (Mantel-Haenszel [M-H] risk ratio 1.67; 95% CI 1.27 to 2.19) and significantly less in the second screening round (M-H RR 0.49; 95% CI 0.37 to 0.66). There were no differences in pooled rates of CIN2+ (M-H RR 1.19; 95% CI 0.94 to 1.50) and CIN3+ (M-H RR 1.09; 95% CI 0.84 to 1.42), but there was a higher pooled rate of CIN2 (M-H RR 1.37; 95% CI 1.12 to 1.68) over two screening rounds. A trend towards lower rates of invasive cervical cancer was observed.
  
  
  CONCLUSIONS
  Organized screening programs in higher resource settings should consider adopting HPV testing as the primary screening test for women 30 or 35 years of age and older. Further research is needed to determine optimal screening strategies for younger women.
authors.affiliation: Division of Gynecologic Oncology, University Health Network, Toronto ON.
authors.forename: Joan
authors.initials: J
authors.lastname: Murphy
authors.affiliation: Program in Evidence-based Care, Cancer Care Ontario and Department of Oncology, McMaster University, Hamilton ON.
authors.forename: Erin B
authors.initials: EB
authors.lastname: Kennedy
authors.affiliation: Family Practice Unit, Women's College Hospital, Toronto ON.
authors.forename: Sheila
authors.initials: S
authors.lastname: Dunn
authors.affiliation: London Health Sciences Centre, London ON.
authors.forename: C Meg
authors.initials: CM
authors.lastname: McLachlin
authors.affiliation: Ottawa General Hospital, Ottawa ON.
authors.forename: Michael Fung
authors.initials: MF
authors.lastname: Kee Fung
authors.affiliation: North Simcoe Muskoka Local Health Integration Network, Huntsville ON.
authors.forename: Danusia
authors.initials: D
authors.lastname: Gzik
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto ON.
authors.forename: Michael
authors.initials: M
authors.lastname: Shier
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto ON.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Paszat
mesh_terms: D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology / Q000821:virology