A LARGE-scale trial conducted in Sweden has revealed that human papillomavirus (HPV)-based cervical screening is more effective than traditional cytology-based screening in reducing the risk of invasive cervical cancer.
The study, which followed 395,725 women aged 30–64 years, compared the two screening methods over 8 years. The trial aimed to assess the real-world performance of HPV-based screening after two full rounds, as previous research had indicated superior outcomes in clinical trials.
The findings show that women invited to undergo HPV-based screening had a 17% lower risk of developing invasive cervical cancer compared to those invited to cytology-based screening. The results were even more striking among those who participated in the screening, with women in the HPV group showing a 28% lower risk.
Despite its effectiveness, the HPV-based screening led to a higher number of referrals for colposcopy and biopsy, as a larger proportion of women were found to require follow-up tests. Among women invited to the HPV screening, 7.5% were referred for further investigation, compared to 6.9% in the cytology group. A similar trend was seen among women who adhered to the protocol.
The study also highlighted significant differences in cancer risk based on test results. Women who were HPV-negative at baseline had a remarkably low risk of developing cervical cancer, with only 1.3 cases per 100,000 person-years. In contrast, those with normal cytology results had a higher risk of 9.1 per 100,000 person-years. Notably, women who tested HPV-positive but had negative cytology triage showed a much higher risk, with those positive for HPV types 16 or 18 facing particularly elevated risks.
Overall, the trial’s results provide robust evidence supporting HPV-based screening as the superior method for preventing invasive cervical cancer in real-world settings, but the authors also highlight the importance of follow-up care for those with positive HPV tests.
Ada Enesco, EMJ
Reference
Wang J et al. Human papillomavirus-based cervical screening and long-term cervical cancer risk: a randomised health-care policy trial in Sweden. Lancet Public Health. 2024;9(11):e886-e895.
