brand logo

Am Fam Physician. 2023;108(2):204-205

Clinical Question

Is the detection of high-grade cervical neoplasia superior with primary human papillomavirus (HPV) testing alone or with cytology cotesting?

Bottom Line

The results of this population-based retrospective Swedish cohort support HPV testing alone as a routine screening approach for cervical cancer. Among individuals confirmed to have cervical intraepithelial neoplasia grade 2, grade 3, or cancer (CIN2+) by biopsy, cytology was positive in less than 0.02% of individuals with negative HPV results. The results did not hold for testing based on clinical or unknown indications; 3.8% of individuals with CIN2+ would have been missed without cytology in addition to HPV testing. (Level of Evidence = 2b)


The study is a large, retrospective, population-based cohort study (N = 208,701) that used Swedish registry data to assess cervical cancer screening outcomes with HPV testing alone vs. HPV testing with cytology. The authors included individuals 40 to 42 years of age in 2019 who had cervical cancer testing (n = 18,674), 10,643 of which were the population of interest (10,664 tests) and were part of the Swedish cervical screening program. The remainder of testing was for clinical (n = 4,529) or unknown (n = 3,481) indications. In most cases, cotesting was on the same day (99.6%). Cotests outside of the 14-day window were excluded. There were 197 individuals who had a biopsy within six months of cotesting with positive results for CIN2+. Of these, 189 had both positive cytology and HPV tests, six had negative cytology with a positive HPV test, and two (less than 0.02%) had positive cytology with a negative HPV test. CIN2+ with positive results from cytology and a negative HPV test was more common among individuals who were tested for clinical or unknown indications (11 out of 290 participants; 3.8%). The prevalence of HPV vaccination in the population studied was not provided.

Already a member/subscriber?  Log In


From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available

Issue Access

  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

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 Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see

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

This series is coordinated by Natasha J. Pyzocha, DO, contributing editor.

A collection of POEMs published in AFP is available at

Continue Reading

More in AFP

More in Pubmed

Copyright © 2023 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.