Cited by 1,810Cervical Cancer and HPV ResearchWomen's cancer prevention and managementGlobal Cancer Incidence and Screening

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Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials

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Ronco, Guglielmo, Dillner, Joakim, Elfström, K Miriam, Tunesi, Sara, Snijders, Peter J F, Arbyn, Marc, Kitchener, Henry, Segnan, Nereo, Gilham, Clare, Giorgi-Rossi, Paolo, Berkhof, Johannes, Peto, Julian, Meijer, Chris J L M·2014·The Lancet

DOI 10.1016/s0140-6736(13)62218-7

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Abstract

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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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: Ronco, Guglielmo
Dillner, Joakim
Elfström, K Miriam
Snijders, Peter J F
Arbyn, Marc
Kitchener, Henry
Segnan, Nereo
Gilham, Clare
Berkhof, Johannes
Peto, Julian
Meijer, Chris J L M
Venue: The Lancet
Publisher: Elsevier BV
Published: 2014-02
Volume: 383
Issue: 9916
Pages: 524-532
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(13)62218-7
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: other-oa
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials

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