Primary HPV Screening Detects More Lesions Than Cytology in Vaccinated Population

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Human papillomavirus (HPV) screening — compared with cytology-based screening — is associated with higher detection rates for precancerous cervical lesions in a country with high HPV vaccination coverage, suggests a PLOS Medicine study.

Australian researchers randomized 5000 women aged 25 to 64 years presenting for cervical screening to liquid-based cytology or HPV screening. Women undergoing HPV screening were referred directly for colposcopy if HPV-16 or 18 was detected, and they underwent either liquid-based or dual-stained cytology triage for other high-risk HPV types. Nearly a quarter of participants had been eligible for HPV vaccination based on age.

After adjustment for vaccination age eligibility, the colposcopy referral rate was similar across the groups (roughly 3%). However, the rate of detected high-grade precancer (CIN2+) was significantly higher with HPV screening than with cytology (roughly 1.0% vs. 0.1%).

The authors conclude: "These findings provide initial support for the implementation of primary HPV screening in vaccinated populations."