Patient-Oriented Evidence That Matters

HPV Testing Better Than Cytology for Women Vaccinated Against HPV


Am Fam Physician. 2018 Sep 15;98(6):384-385.

Clinical Question

What is the best means of cervical cancer screening in women who have received the human papillomavirus (HPV) vaccination?

Bottom Line

In women who had received the HPV vaccine, screening for HPV every five years, with cytology and colposcopy follow-up as needed, resulted in higher rates of identification of high-grade pre-cancerous disease (cervical intraepithelial neoplasia grade 2 or higher [CIN2+]) than standard liquid-based cytology every 2.5 years with HPV follow-up cotesting as needed. (Level of Evidence = 1b)


In Australia, where this study was performed, all women included in this aspect of the study had been offered the HPV vaccination, either at age 12 or 13 years or later as a catch-up, with an estimated 50% to 77% of women receiving all three doses. In this study, 1,078 women younger than 33 years who had been offered the HPV vaccine were randomized, using concealed allocation, to cervical cancer screening using one of three strategies: (1) liquid-based cytology (ThinPrep) every 2.5 years with follow-up HPV cotesting if the results were abnormal; (2) HPV testing every five years with follow-up cytology or colposcopy if the results were abnormal; or (3) HPV testing every five years with follow-up cell staining for oncogenic markers in women with identified oncogenic HPV (HPV 16 or 18) on initial screening (further details of follow-up testing and confirmation is available at https://goo.gl/J3MX4V). Rates of identification of high-grade precancerous disease (CIN2+) were higher in women in each HPV testing arm (2.6% and 2.9%) than with cytology (0.5%; P = .05). The researchers do not know the percentage of eligible women who received the vaccine, and most of the women had been screened at some point before the study was started, biasing the sample toward lower rates of disease.

Study design: Randomized controlled trial (nonblinded)

Funding source: Foundation

Allocation: Concealed

Setting: Outpatient (any)

Reference: Canfell K, Caruana M, Gebski V, et al. Cervical screening with primary HPV testing or cytology in a population of women in which those aged 33 years or younger had previously been offered HPV vaccination: results of the Compass pilot randomised trial. PLoS Med. 2017;14(9):e1002388.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.



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