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Cited by 142Cervical Cancer and HPV ResearchWomen's cancer prevention and managementReproductive tract infections research

Long term duration of protective effect for HPV negative women: follow-up of primary HPV screening randomised controlled trial

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Elfstrom, K. M., Smelov, V., Johansson, A. L. V., Eklund, C., Naucler, P., Arnheim-Dahlstrom, L., Dillner, J.·2014·BMJ
DOI 10.1136/bmj.g130PMC PMC3898575
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Abstract

OBJECTIVES: To assess whether the increased sensitivity of screening for human papillomavirus (HPV) may represent overdiagnosis and to compare the long term duration of protective effect against cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in HPV based and cytology based screening. DESIGN: 13 year follow-up of the Swedescreen randomised controlled trial of primary HPV screening. SETTING: Organised cervical screening programme in Sweden. PARTICIPANTS: 12,527 women aged 32-38 attending organised screening were enrolled and randomised to HPV and cytology double testing (intervention arm, n=6257) or to cytology only, with samples frozen for future HPV testing (control arm, n=6270). MAIN OUTCOME MEASURES: Cumulative incidence of CIN2+ and CIN3+ (Kaplan Meier curves). Longitudinal test characteristics were calculated for cytology only, HPV testing only, and cytology and HPV testing combined, adjusting for censoring. RESULTS: The increased detection of CIN2+ in the intervention arm decreased over time. After six years, the cumulative incidence of CIN3+ was similar in both trial arms, and after 11 years the cumulative incidence of CIN2+ became similar in both arms. The longitudinal sensitivity of cytology for CIN2+ in the control arm at three years was similar to the sensitivity of HPV testing in the intervention arm at five years of follow-up: 85.94% (95% confidence interval 76.85% to 91.84%) v 86.40% (79.21% to 91.37%). The sensitivity of HPV screening for CIN3+after five years was 89.34% (80.10% to 94.58%) and for cytology after three years was 92.02% (80.59% to 96.97%). CONCLUSIONS: Over long term follow-up, the cumulative incidence of CIN2+ was the same for HPV screening and for cytology, implying that the increased sensitivity of HPV screening for CIN2+ reflects earlier detection rather than overdiagnosis. The low long term risks of CIN3+ among women who tested negative in HPV screening, support screening intervals of five years for such women. TRIAL REGISTRATION: Clinicaltrials.gov NCT00479375.

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  • HPV testing has high sensitivity for detecting precancerous lesions in WLHIV and inherent advantages of objectivity and reproducibility compared to visual inspection methods like VIA or subjective assessments like cytology.

    “The rationale for this choice lies in HPV testing’s high sensitivity for detecting precancerous lesions in WLHIV and its inherent advantages of objectivity and reproducibility compared to visual inspection methods like VIA or subjective assessments like cytology [19–23].”

    From HPV Screening in Women Living with HIV (WLHIV) in Karnataka, India: Can it be Integrated into ART Centres? (2025) · cites this paper as [20]

    The Introduction states that HPV DNA testing has higher sensitivity for detecting cervical intraepithelial neoplasia, and the Results report sensitivity for CIN2+ and CIN3+. The paper does not establish that finding specifically in women living with HIV, nor does it compare HPV testing’s objectivity or reproducibility with VIA or cytology. (LLM, conf=0.88)

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Cited by

Sorted by citations

Authors
Elfstrom, K. M., Smelov, V., Johansson, A. L. V., Eklund, C., Naucler, P., Arnheim-Dahlstrom, L., & Dillner, J.
Affiliations
Karolinska Institutet (SE)
Corresponding author
Dillner, J.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2014-01-16
Volume
348
Issue
jan16 1
Pages
g130-g130
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj.g130
PMC
PMC3898575
OpenAlex
W2165412776
Cited by
142
References
1
Citations by year
2026: 11 · 2025: 6 · 2024: 9 · 2023: 11 · 2022: 6 · 2021: 12 · 2020: 9 · 2019: 17 · 2018: 12 · 2017: 11 · 2016: 10 · 2015: 18 · 2014: 9 · 2013: 1
FWCI
12.12
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
Cancerfonden
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
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Keywords
HPV testing, cervical cancer screening, cervical intraepithelial neoplasia, overdiagnosis, cytology, primary HPV testing, screening frequency, long-term follow-up, screening sensitivity, cervical cancer prevention
MeSH terms
Adult, Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Diagnosis, Differential, DNA, Viral, Female, Follow-Up Studies, Humans, Mass Screening, Middle Aged, Neoplasm Staging, Retrospective Studies, Sweden, Vaginal Smears, Reproducibility of Results, Incidence, Papillomaviridae, Papillomavirus Infections, Young Adult

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