title: Co-testing for detection of high-grade cervical intraepithelial neoplasia and cancer compared with cytology alone: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Human papillomavirus (HPV) DNA testing combined with cytology has been recommended as a primary cervical cancer screening strategy.
  
  
  METHODS
  PubMed/MEDLINE, Embase, the Cochrane Library and the NIH trial registry were searched for randomized controlled trials comparing co-testing with cytology alone for the detection of high-grade CIN lesions and cancers. Of 1156 articles identified, four met inclusion criteria. The performance of co-testing and cytology alone was compared at baseline screening, second round screening and overall. Cumulative meta-analysis, Begg's test, Egger's test and sensitivity analysis were performed.
  
  
  RESULTS
  At baseline, co-testing was associated with a significantly higher detection rate of CIN 2+ [risk ratio (RR) = 1.41, 95% confidence interval (CI): 1.12, 1.76] and a non-significantly higher CIN 3+ detection rate (RR = 1.15, 95% CI: 0.99, 1.33). At second round screening, co-testing was associated with significantly lower detection rates of both CIN 2+ and CIN 3+ (RR = 0.77, 95% CI: 0.63, 0.93; RR = 0·68, 95% CI: 0.55, 0.85). The overall detection rate did not differ between co-testing and cytology alone for CIN 2+ (RR: 1·19, 95% CI: 0.99, 1.46) or CIN3+ (RR: 0.99, 95% CI: 0.87, 1.14).
  
  
  CONCLUSIONS
  Co-testing increases the detection of CIN2+ lesions at baseline and significantly decreases the detection rates of CIN2+ or CIN3+ lesions at subsequent screening compared with cytology alone.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Harvard University, Boston, MA, USA.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Bouchard-Fortier
authors.forename: Kaveh
authors.initials: K
authors.lastname: Hajifathalian
authors.forename: Marla D
authors.initials: MD
authors.lastname: McKnight
authors.forename: David G
authors.initials: DG
authors.lastname: Zacharias
authors.forename: Luis Alonso
authors.initials: LA
authors.lastname: Gonzalez-Gonzalez
mesh_terms: D000328:Adult; D000368:Aged; D004279:DNA, Viral / Q000235:genetics; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics; D030361:Papillomavirus Infections / Q000175:diagnosis; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000379:methods; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*
chemical_list: D004279:DNA, Viral
keywords: cancer; gynaecological disorders; screening