Primary Human Papillomavirus (HPV) Testing versus Cytology for Cervical Cancer Screening: A Systematic Review

Abstract

Introduction: Cervical cancer screening has traditionally relied on cytology (Pap test). Primary screening with tests for high-risk human papillomavirus (HPV) has been proposed as a more effective alternative. This review compares the two screening strategies.

Methods: A systematic review of RCTs was conducted, comparing primary HPV testing to conventional or liquid-based cytology. The primary outcome was the detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+).

Results: The pooled analysis showed that primary HPV testing had a significantly higher sensitivity for the detection of CIN3+ compared to cytology. This increased sensitivity led to a lower incidence of cervical cancer in subsequent screening rounds in the HPV-screened group. The specificity of HPV testing was lower.

Discussion: The superior sensitivity of HPV testing allows for a more effective screening program with the potential for longer screening intervals. Triage testing (e.g., with cytology or genotyping) is necessary to manage the lower specificity.

Conclusion: Primary HPV testing is more effective than cytology for cervical cancer screening, offering greater protection against invasive cancer.