Advanced

Human papillomavirus and Papanicolaou tests to screen for cervical cancer.

Naucler, Pontus LU ; Ryd, Walter; Tornberg, Sven; Strand, Anders; Wadell, Goran; Elfgren, Kristina; Radberg, Thomas; Strander, Björn; Forslund, Ola LU and Hansson, Bengt-Göran LU , et al. (2007) In New England Journal of Medicine 357(16). p.1589-1597
Abstract
Background Screening for cervical cancer based on testing for human papillomavirus (HPV) increases the sensitivity of detection of high-grade (grade 2 or 3) cervical intraepithelial neoplasia, but whether this gain represents overdiagnosis or protection against future high-grade cervical epithelial neoplasia or cervical cancer is unknown. Methods In a population-based screening program in Sweden, 12,527 women 32 to 38 years of age were randomly assigned at a 1:1 ratio to have an HPV test plus a Papanicolaou (Pap) test (intervention group) or a Pap test alone (control group). Women with a positive HPV test and a normal Pap test result were offered a second HPV test at least 1 year later, and those who were found to be persistently infected... (More)
Background Screening for cervical cancer based on testing for human papillomavirus (HPV) increases the sensitivity of detection of high-grade (grade 2 or 3) cervical intraepithelial neoplasia, but whether this gain represents overdiagnosis or protection against future high-grade cervical epithelial neoplasia or cervical cancer is unknown. Methods In a population-based screening program in Sweden, 12,527 women 32 to 38 years of age were randomly assigned at a 1:1 ratio to have an HPV test plus a Papanicolaou (Pap) test (intervention group) or a Pap test alone (control group). Women with a positive HPV test and a normal Pap test result were offered a second HPV test at least 1 year later, and those who were found to be persistently infected with the same high-risk type of HPV were then offered colposcopy with cervical biopsy. A similar number of double-blinded Pap smears and colposcopies with biopsy were performed in randomly selected women in the control group. Comprehensive registry data were used to follow the women for a mean of 4.1 years. The relative rates of grade 2 or 3 cervical intraepithelial neoplasia or cancer detected at enrollment and at subsequent screening examinations were calculated. Results At enrollment, the proportion of women in the intervention group who were found to have lesions of grade 2 or 3 cervical intraepithelial neoplasia or cancer was 51% greater (95% confidence interval [CI], 13 to 102) than the proportion of women in the control group who were found to have such lesions. At subsequent screening examinations, the proportion of women in the intervention group who were found to have grade 2 or 3 lesions or cancer was 42% less (95% CI, 4 to 64) and the proportion with grade 3 lesions or cancer was 47% less (95% CI, 2 to 71) than the proportions of control women who were found to have such lesions. Women with persistent HPV infection remained at high risk for grade 2 or 3 lesions or cancer after referral for colposcopy. Conclusions The addition of an HPV test to the Pap test to screen women in their mid-30s for cervical cancer reduces the incidence of grade 2 or 3 cervical intraepithelial neoplasia or cancer detected by subsequent screening examinations. (Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adult, Cervical Intraepithelial Neoplasia: diagnosis, Cervical Intraepithelial Neoplasia: pathology, Cervical Intraepithelial Neoplasia: prevention & control, DNA, Colposcopy, Sensitivity and Specificity, Polymerase Chain Reaction, Papillomavirus Infections: diagnosis, Papillomaviridae: isolation & purification, Mass Screening, Papillomaviridae: genetics, Vaginal Smears, Viral: analysis, Double-Blind Method, Female, Humans, Uterine Cervical Neoplasms: diagnosis, Uterine Cervical Neoplasms: prevention & control, Uterine Cervical Neoplasms: pathology
in
New England Journal of Medicine
volume
357
issue
16
pages
1589 - 1597
publisher
Massachusetts Medical Society
external identifiers
  • wos:000250200500004
  • scopus:35349004609
ISSN
0028-4793
language
English
LU publication?
yes
id
ab62fec5-4647-4e40-9c36-2775254be19e (old id 608508)
alternative location
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=17942872&dopt=Abstract
date added to LUP
2007-12-17 10:31:20
date last changed
2017-11-12 03:27:15
@article{ab62fec5-4647-4e40-9c36-2775254be19e,
  abstract     = {Background Screening for cervical cancer based on testing for human papillomavirus (HPV) increases the sensitivity of detection of high-grade (grade 2 or 3) cervical intraepithelial neoplasia, but whether this gain represents overdiagnosis or protection against future high-grade cervical epithelial neoplasia or cervical cancer is unknown. Methods In a population-based screening program in Sweden, 12,527 women 32 to 38 years of age were randomly assigned at a 1:1 ratio to have an HPV test plus a Papanicolaou (Pap) test (intervention group) or a Pap test alone (control group). Women with a positive HPV test and a normal Pap test result were offered a second HPV test at least 1 year later, and those who were found to be persistently infected with the same high-risk type of HPV were then offered colposcopy with cervical biopsy. A similar number of double-blinded Pap smears and colposcopies with biopsy were performed in randomly selected women in the control group. Comprehensive registry data were used to follow the women for a mean of 4.1 years. The relative rates of grade 2 or 3 cervical intraepithelial neoplasia or cancer detected at enrollment and at subsequent screening examinations were calculated. Results At enrollment, the proportion of women in the intervention group who were found to have lesions of grade 2 or 3 cervical intraepithelial neoplasia or cancer was 51% greater (95% confidence interval [CI], 13 to 102) than the proportion of women in the control group who were found to have such lesions. At subsequent screening examinations, the proportion of women in the intervention group who were found to have grade 2 or 3 lesions or cancer was 42% less (95% CI, 4 to 64) and the proportion with grade 3 lesions or cancer was 47% less (95% CI, 2 to 71) than the proportions of control women who were found to have such lesions. Women with persistent HPV infection remained at high risk for grade 2 or 3 lesions or cancer after referral for colposcopy. Conclusions The addition of an HPV test to the Pap test to screen women in their mid-30s for cervical cancer reduces the incidence of grade 2 or 3 cervical intraepithelial neoplasia or cancer detected by subsequent screening examinations.},
  author       = {Naucler, Pontus and Ryd, Walter and Tornberg, Sven and Strand, Anders and Wadell, Goran and Elfgren, Kristina and Radberg, Thomas and Strander, Björn and Forslund, Ola and Hansson, Bengt-Göran and Rylander, Eva and Dillner, Joakim},
  issn         = {0028-4793},
  keyword      = {Adult,Cervical Intraepithelial Neoplasia: diagnosis,Cervical Intraepithelial Neoplasia: pathology,Cervical Intraepithelial Neoplasia: prevention & control,DNA,Colposcopy,Sensitivity and Specificity,Polymerase Chain Reaction,Papillomavirus Infections: diagnosis,Papillomaviridae: isolation & purification,Mass Screening,Papillomaviridae: genetics,Vaginal Smears,Viral: analysis,Double-Blind Method,Female,Humans,Uterine Cervical Neoplasms: diagnosis,Uterine Cervical Neoplasms: prevention & control,Uterine Cervical Neoplasms: pathology},
  language     = {eng},
  number       = {16},
  pages        = {1589--1597},
  publisher    = {Massachusetts Medical Society},
  series       = {New England Journal of Medicine},
  title        = {Human papillomavirus and Papanicolaou tests to screen for cervical cancer.},
  volume       = {357},
  year         = {2007},
}