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Word of the Day

HPV screening every 5 years = Pap smear every 3 years

Clinical Question:
Is screening for human papillomavirus an effective approach to identifying women at low risk for cervical cancer?

Bottom Line:
A single human papillomavirus (HPV) test provides the same degree of protection over 5 years as a Pap smear does for 3 years. We may soon see a recommendation of HPV testing as a stand-alone screen, with cytology reserved for women who are HPV positive. We may also be able to extend the screening interval to at least 5 years. (LOE = 1b)

Reference:
Elfstrom KM, Smelov V, Johansson AL, et al. Long-term duration of protective effect for HPV negative women: follow-up of primary HPV screening randomised controlled trial. BMJ 2014;348:g130.  [PMID:24435414]

Study Design:
Cohort (prospective)

Funding:
Foundation

Setting:
Population-based

Synopsis:
This analysis comes from the Swedescreen randomized controlled trial, which invited women aged 32 years to 38 years from 1997 to 2000 to be screened for HPV while also being screened for cervical cancer using standard cytology. Of the 12,091 women enrolled, 387 women developed cervical intraepithelial neoplasia grade 2 or worse (CIN2+; 3.2%) and 230 ((1.9%) developed grade 3 or worse (CIN3+) over a median 11 years of follow-up. HPV screening every 5 years had a sensitivity (across both arms of the study) of 89% to 92% and a specificity of 91% to 93.5% for CIN3+. These characteristics are similar to cytology screening results at 3 years (77% - 92% and 98%). The combination of cytology and HPV screening increased sensitivity slightly at 5 years (92% - 95%). Women with a positive HPV screening result were not at an increased likelihood of being diagnosed with CIN2+ or CIN3+ as compared with cytology, therefore making the risk of overdiagnosis low.

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