HPV for cervical cancer screening (HPV FOCAL): Complete Round 1 results of a randomized trial comparing HPV‐based primary screening to liquid‐based cytology for cervical cancer

• Published in: International journal of cancer 2017-01, Vol.140 (2), p.440-448
• Main Authors: Ogilvie, Gina S., Krajden, Mel, van Niekerk, Dirk, Smith, Laurie W., Cook, Darrel, Ceballos, Kathy, Lee, Marette, Gentile, Laura, Gondara, Lovedeep, Elwood‐Martin, Ruth, Peacock, Stuart, Stuart, Gavin, Franco, Eduardo L., Coldman, Andrew J.
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Cancer; Cellular biology; Cervical cancer; cervical cancer screening; Colposcopy - methods; DNA, Viral - genetics; Early Detection of Cancer - methods; Female; HPV; Human papillomavirus; Humans; Mass Screening - methods; Medical research; Medical screening; Middle Aged; molecular‐based testing; Papillomaviridae; Papillomaviridae - genetics; Papillomaviridae - isolation & purification; Papillomavirus Infections - diagnosis; Papillomavirus Infections - virology; Referral and Consultation; Sensitivity and Specificity; Triage - methods; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - virology; Vaginal Smears - methods
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.30454

Complete Round 1 data (baseline and 12‐month follow‐up) for HPV FOCAL, a randomized trial establishing the efficacy of HPV DNA testing with cytology triage as a primary screen for cervical cancer are presented. Women were randomized to one of three arms: Control arm – Baseline liquid‐based cytology (LBC) with ASCUS results triaged with HPV testing; Intervention and Safety arms – Baseline HPV with LBC triage for HPV positives. Results are presented for 15,744 women allocated to the HPV (intervention and safety combined) and 9,408 to the control arms. For all age cohorts, the CIN3+ detection rate was higher in the HPV (7.5/1,000; 95%CI: 6.2, 8.9) compared to the control arm (4.6/1,000; 95%CI: 3.4, 6.2). The CIN2+ detection rates were also significantly higher in the HPV (16.5/1,000; 95%CI: 14.6, 18.6) vs. the control arm (10.1/1,000; 95%CI: 8.3, 12.4). In women ≥35 years, the overall detection rates for CIN2+ and CIN3+ were higher in the HPV vs. the control arm (CIN2+:10.0/1,000 vs. 5.2/1,000; CIN3+: 4.2/1,000 vs. 2.2/1,000 respectively, with a statistically significant difference for CIN2+). HPV testing detected significantly more CIN2+ in women 25–29 compared to LBC (63.7/1,000; 95%CI: 51.9, 78.0 vs. 32.4/1,000; 95%CI: 22.3, 46.8). HPV testing resulted in significantly higher colposcopy referral rates for all age cohorts (HPV: 58.9/1,000; 95%CI: 55.4, 62.7 vs. control: 30.9/1,000; 95%CI: 27.6, 34.6). At completion of Round 1 HPV‐based cervical cancer screening in a population‐based program resulted in greater CIN2+ detection of across all age cohorts compared to LBC screening. What's new? Human papillomavirus (HPV)‐based testing shows improved sensitivity and negative predictive value over conventional Pap smear for cervical cancer screening. According to data from Round 1 of the Canadian HPV FOCAL trial, presented here, HPV‐based testing also outperforms liquid‐based cytology (LBC), a widely used alternative to conventional Pap smear. The results show that across age cohorts, HPV testing detected more cases of moderate‐ to high‐grade cervical intraepithelial neoplasia (CIN2+) than LBC screening. HPV testing also was associated with increased colposcopy referral rates. The findings may be of use to cervical cancer screening programs considering implementation of HPV‐based testing.