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Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials
Open accessAbstract
Background In four randomised trials, human papillomavirus (HPV)-based screening for cervical cancer was compared with cytology-based cervical screening, and precursors of cancer were the endpoint in every trial. However, direct estimates are missing of the relative efficacy of HPV-based versus cytology-based screening for prevention of invasive cancer in women who undergo regular screening, of modifiers (eg, age) of this relative efficacy, and of the duration of protection. We did a follow-up study of the four randomised trials to investigate these outcomes. Methods 176,464 women aged 20-64 years were randomly assigned to HPV-based (experimental arm) or cytology-based (control arm) screening in Sweden (Swedescreen), the Netherlands (POBASCAM), England (ARTISTIC), and Italy (NTCC). We followed up these women for a median of 6·5 years (1,214,415 person-years) and identified 107 invasive cervical carcinomas by linkage with screening, pathology, and cancer registries, by masked review of histological specimens, or from reports. Cumulative and study-adjusted rate ratios (experimental vs control) were calculated for incidence of invasive cervical carcinoma. Findings The rate ratio for invasive cervical carcinoma among all women from recruitment to end of follow-up was 0·60 (95% CI 0·40-0·89), with no heterogeneity between studies (p=0·52). Detection of invasive cervical carcinoma was similar between screening methods during the first 2·5 years of follow-up (0·79, 0·46-1·36) but wa…
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“We now have high level evidence that screening by hrHPV testing is more effective than screening by cytology for protecting against future cervical precancer and cancer.18 20”
From Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses (2018) · cites this paper as [20]
In the citing paper
“Of these, high-risk HPV (hrHPV) DNA-based screening tests have been shown to provide 60%–70% greater effectiveness in detecting invasive cervical carcinomas compared with cytology in several large-scale randomized trials [3].”
From A community‐based, cross‐sectional study of hr HPV DNA self‐sampling‐based cervical cancer screening in rural Karnataka, India (2019) · cites this paper as [3]
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“and are likely to be more effective at preventing cervical cancer than visual inspection with acetic acid or cytology.14, 15, 16”
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“Randomised controlled trials have shown that HPV-based tests are highly effective at detecting precancerous lesions”
In the citing paper
“Randomised controlled trials have shown that HPV-based tests are highly effective at detecting precancerous lesions”
In the citing paper
“and are likely to be more effective at preventing cervical cancer than visual inspection with acetic acid or cytology.14, 15, 16”
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Self-citation
Metadata
- Authors
- Ronco, G., Dillner, J., Elfström, K. M., Tunesi, S., Snijders, P. J. F., Arbyn, M., Kitchener, H., Segnan, N., Gilham, C., Giorgi-Rossi, P., Berkhof, J., Peto, J., & Meijer, C. J. L. M.
- Affiliations
- Karolinska Institutet (SE)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Institut Scientifique de Santé Publique (BE)
- University of Manchester (GB)
- Centre international de recherche sur le cancer (FR)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Ronco, Guglielmo
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2014-02
- Volume
- 383
- Issue
- 9916
- Pages
- 524-532
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2121732950
- Cited by
- 1,810
- References
- 31
- Citations by year
- 2026: 136 · 2025: 141 · 2024: 166 · 2023: 150 · 2022: 140 · 2021: 149 · 2020: 161 · 2019: 152 · 2018: 130 · 2017: 131 · 2016: 131 · 2015: 129 · 2014: 83
- FWCI
- 84.20
- Type
- journal article
- Language
- en
- Open access
- green
- zenodo.org
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
- Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- PREDHICT project (242061)
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- HPV-based cervical cancer screening, invasive cervical cancer, cytology-based screening, cancer prevention, screening efficacy, duration of protection, cervical cancer incidence, cervical cancer screening guidelines
- MeSH terms
- Adult, Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Colposcopy, Cytological Techniques, Europe, Female, Follow-Up Studies, Humans, Middle Aged, Neoplasm Invasiveness, Precancerous Conditions, Multicenter Studies as Topic, Incidence, Randomized Controlled Trials as Topic, Papillomavirus Infections, Early Detection of Cancer, Young Adult
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