Compared with liquid-based cytology, routine primary high-risk HPV (hrHPV) screening was found to significantly improve the detection of cervical intraepithelial neoplasia (CIN) and cervical cancer, according to an observational study published in BMJ.

A team of UK-based investigators for The English Cervical Screening Programme compiled data on the prevalence and incidence of high-grade CIN among women who had routine primary hrHPV testing compared with primary liquid-based cytology screening.

Participants included 578,547 women between ages 24 and 64 who underwent cervical screening in the primary care setting with follow-up in 3 years; 32% underwent screening with hrHPV testing and 68% underwent screening with liquid-based cytology.

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Of the women who underwent hrHPV testing, 12.7% tested positive, while 3.8% of those undergoing liquid-based cytology tested positive. Nearly one-third of those who had positive hrHPV results were HPV 16/18 positive.

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Compared with liquid-based cytology, hrHPV testing detected 50% more CIN grade 2 or worse, 40% more CIN grade 3 or worse, and 30% more cervical cancer. Although hrHPV testing has reduced specificity vs cytology — approximately 80% more colposcopies were needed for women with hrHPV testing — positive test results can be followed by reflex liquid-based cytology to mitigate excessive referral for a colposcopy.

“At present, 2500 women are diagnosed with cervical cancer each year in England, with a quarter diagnosed after negative cytology. Screening with hrHPV testing would translate to 400-500 fewer cases, or an about 20% decrease in the overall incidence, once hrHPV testing is rolled out nationally” … “This pilot undertaken under routine screening conditions has confirmed that primary care hrHPV cervical screening is practicable on a large scale …” the authors noted.


Rebolj M, Rimmer J, Denton K, et al. Primary cervical screening with high risk human papillomavirus testing: observational study. BMJ. 2019;364:I240