Women in the intervention group received HPV testing; those whose results were negative returned at 48 months. Women in the control group received liquid-based cytology (LBC) testing; those whose results were negative returned at 24 months for LBC. Authors highlight that further research is needed to understand long-term clinical outcomes as well as cost-effectiveness.
A related editorial discusses this research. Cytology-based screening has led to substantial risk reductions in more developed countries. The leading candidate to replace cytology testing for cervical cancer screening is testing for human papillomavirus (HPV), the cause of virtually all cervical cancers. Despite many barriers to implementation of HPV testing. multiple randomised trials have shown that primary HPV screening linked to subsequent identification and treatment of cervical pre-cancer is more effective than cytology testing in reducing the incidence of cervical cancer and pre-cancer, at the cost of lower specificity and more false-negative subsequent colposcopic assessments. Implementation of HPV testing as a primary screen still requires substantial patient education. Women will need to understand the importance of testing for these sexually transmitted viruses, including that HPV infections are almost ubiquitous, may regress, and can be followed without therapy unless progressing toward cancer. Clinicians will have to choose between primary HPV testing and co-testing based on modeling and cost-effectiveness. Amid this substantial shift, new screening tools must be combined with redoubled efforts to engage inadequately screened women in order to make further progress against cervical cancer.