Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials
- Study type
- Meta-analysis
- Study name
- Swedescreen / POBASCAM / ARTISTIC / NTCC
- Design
- Pooled follow-up analysis of four European randomised controlled trials (Swedescreen in Sweden, POBASCAM in the Netherlands, ARTISTIC in England and NTCC in Italy)
- Sample size
- 176,464 women
- Source
- The Lancet · 2014
In plain words
This study put together the results of four large European trials in more than 176 thousand women to find out whether testing for the HPV virus or cytology (the smear test) prevents cervical cancer better when used for screening. Compared with cytology, HPV-based screening gave 60 to 70% more protection against invasive cervical cancers. Women whose first test was negative developed invasive cancer much less often in the HPV group. These findings support starting HPV screening at age 30 and leaving at least 5 years between screenings.
Key results
Treatment arms and regimens
Cervical cancer screening based on testing for human papillomavirus (HPV).
Cervical cancer screening based on cytology.
Source of the regimen details: Abstract of the paper (follow-up of screening trials; no drug intervention)
Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.
Study population
Women aged 20 to 64 years randomly assigned to HPV-based or cytology-based screening in Sweden (Swedescreen), the Netherlands (POBASCAM), England (ARTISTIC) and Italy (NTCC).
Endpoints
Endpoint studied: incidence of invasive cervical carcinoma. Cumulative and study-adjusted rate ratios (experimental versus control arm) were calculated. The effects of factors such as age, stage and histological type and the duration of protection were also examined.
Safety and side effects
The abstract gives no information on adverse effects or harms of screening.
Clinical significance and place in guidelines
Based on the abstract, data from randomised trials support starting HPV-based screening at age 30 and extending the screening interval to at least 5 years. The extent to which these findings have been adopted in national or international guidelines should be checked separately in current guidelines and cannot be inferred from the abstract.
Limitations
Based on the abstract, the total number of invasive carcinomas was limited (107 cases), so the confidence intervals in some subgroups (such as the 30 to 34 age group and the cumulative incidence estimates) are wide. The difference in the first 2.5 years of follow-up was not significant. Other points should be checked in the full text of the paper.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.