Clinical question
Compared with cytological testing (liquid-based and conventional), how effective is human papillomavirus (HPV) testing for detecting histologically confirmed cervical intraepithelial neoplasia (CIN) of grade 2 or worse (CIN 2+), including adenocarcinoma in situ, in women participating in primary cervical cancer screening?
Bottom line
For every 1000 women screened, around 20 women have precancerous changes. The HPV test correctly identified 16 of these women (but would miss 4). Cervical cytology identified 12 of the women (but would miss 8). For every 1000 women screened, there are 980 women who do not have precancerous changes. The HPV test correctly identified 879 women (but 101 women would be incorrectly told they have a lesion). Cervical cytology correctly identified 951 women (but 29 would be incorrectly told they have a lesion). Overall, the quality of the evidence for the sensitivity of the tests was moderate, and high for the specificity.
Caveat
Some of the results from the studies were different from each other. For example, tests were more accurate in studies in Europe than in Asia or Central or South America. Overall, the quality of the evidence was moderate to high.
Context
Cervical cancer screening has traditionally been based on cervical cytology. Given the aetiological relationship between HPV infection and cervical carcinogenesis, HPV testing has been proposed as an alternative screening test.
Cochrane Systematic Review
Koliopoulos G et al. Cytology versus HPV testing for cervical cancer screening in the general population. Cochrane Reviews, 2017, Issue 8. Art. No.: CD008587.DOI: 10.1002/14651858. CD008587.pub2. This review contains 40 studies involving 140,000 participants.
Cochrane Systematic Reviews for primary care practitioners – developed by the Cochrane Primary Care Field, New Zealand Branch of the Australasian Cochrane Centre at the Department of General Practice and Primary Health Care, University of Auckland and funded by the Ministry of Health. Brian McAvoy is an honorary/adjunct professor of general practice at the Universities of Auckland, Melbourne, Monash and Queensland.New Zealanders can access the Cochrane Library free via http://nz.cochrane.org
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