Primary cervical screening with high risk human papillomavirus testing: observational study

作者：Matejka Rebolj, Janet Rimmer, Karin J. Denton, JOHN A. TIDY, Christopher S. Mathews, Kay Ellis, John A. Smith, Chris Evans, Thomas Giles, Viki Frew, Xenia Tyler, Alexandra Sargent, JANET A. PARKER, Miles Holbrook, Katherine J. Hunt, Penny Tidbury, Tanya Levine, David M. Smith, Julietta Patnick, Ruth Stubbs, Sue Moss, Henry Charles Kitchener · 发表于：BMJ · 年份：2019 · DOI：10.1136/bmj.l240 · 被引用次数：179 · 研究领域：Cervical Cancer and HPV Research、Reproductive tract infections research、Global Cancer Incidence and Screening

OBJECTIVE: To provide the first report on the main outcomes from the prevalence and incidence rounds of a large pilot of routine primary high risk human papillomavirus (hrHPV) testing in England, compared with contemporaneous primary liquid based cytology screening. DESIGN: Observational study. SETTING: The English Cervical Screening Programme. PARTICIPANTS: 578 547 women undergoing cervical screening in primary care between May 2013 and December 2014, with follow-up until May 2017; 183 970 (32%) were screened with hrHPV testing. INTERVENTIONS: Routine cervical screening with hrHPV testing with liquid based cytology triage and two early recalls for women who were hrHPV positive and cytology negative, following the national screening age and interval recommendations. MAIN OUTCOME MEASURES: Frequency of referral for a colposcopy; adherence to early recall; and relative detection of cervical intraepithelial neoplasia grade 2 or worse from hrHPV testing compared with liquid based cytology in two consecutive screening rounds. RESULTS: Baseline hrHPV testing and early recall required approximately 80% more colposcopies, (adjusted odds ratio 1.77, 95% confidence interval 1.73 to 1.82), but detected substantially more cervical intraepithelial neoplasia than liquid based cytology (1.49 for cervical intraepithelial neoplasia grade 2 or worse, 1.43 to 1.55; 1.44 for cervical intraepithelial neoplasia grade 3 or worse, 1.36 to 1.51) and for cervical cancer (1.27, 0.99 to 1.63). Attendanc...