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Human papillomavirus and Papanicolaou tests to screen for cervical cancer . 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 . ( ClinicalTrials.gov number , NCT00479375 [ ClinicalTrials.gov ] . ) .
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Intervention_Other
Human papillomavirus
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Intervention_Other
Papanicolaou tests
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Intervention_Other
HPV test
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Intervention_Other
Papanicolaou ( Pap ) test
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Intervention_Physical
Pap test
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Intervention_Other
HPV test
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Intervention_Other
Pap test
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Intervention_Other
HPV test
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Intervention_Other
Pap smears
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Intervention_Physical
and colposcopies with biopsy
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Intervention_Other
intervention
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Intervention_Control
control
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Intervention_Other
intervention
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Intervention_Control
control
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Intervention_Other
HPV test
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Intervention_Other
Pap test
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Outcome_Physical
double-blinded Pap smears
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Outcome_Other
and colposcopies with biopsy
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Outcome_Physical
rates of grade 2 or 3 cervical intraepithelial neoplasia
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Outcome_Other
or cancer detected
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Outcome_Physical
lesions of grade 2 or 3 cervical intraepithelial neoplasia
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Outcome_Other
or
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Outcome_Physical
cancer
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Outcome_Physical
2 or 3 lesions or cancer
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Participant_Sample-size
12,527
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Participant_Sex
women
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Participant_Age
32 to 38 years of age
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Participant_Sex
women
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Participant_Age
mid-30s