Human papillomavirus testing for primary screening of cervical cancer precursors

Our objective was to determine whether the addition of human papillomavirus (HPV) testing to screening cytology improves the detection of cervical can cer precursors. Women of ages 18-69 gears underwent conventional Pap cytolo gy and HPV DNA testing in a multicenter study in Newfoundland, Canada. Thos e with positive cytology and/or NPV and a random sample of those with dual negative results were referred for colposcopy. The study enrolled 2098 wome n. The relative sensitivity of HPV testing was significantly higher than cy tology fur all-grade squamous intraepithelial lesions [SILs; 73%; 95% confi dence interval (CI), 62-82] and high grade SILs (HSILs; 90%; 95% CI, 74-97) but had lower relative specificity (62% fur all-grade SILs and 51% for HSI Ls) than most cytological cutpoints. The rate of combined correct results f or all-grade lesions was higher for HPV testing (68.8%) than for any cytolo gical cutpoint (equivocal, 52.3%; LSILs, 51.6%; HSILs, 44.5%), The combinat ion of HPV and an LSIL cutpoint had a negative predictive value of 68% (95% CI, 52-80) for all SILs and 100% (95% CI, 91-100) for HSILs, while referri ng For colposcopy only 12% of the women. We concluded that HPV testing in c onjunction with cytology improved the screening efficacy of cytology alone and may allow for a more effective and safe primary screening program with increased screening intervals.