The HPV test has similar sensitivity but more overdiagnosis than the Pap test - A randomised health services study on cervical cancer screening in Finland

摘要

We compared test sensitivity (in terms of prevented cancers) and overdiagnosis (in terms of non-progressive pre-invasive lesions) between the human papillomavirus test (HPV test, Hybrid Capture 2) and the traditional Pap test in routine screening for cervical cancer. The design was a randomised (1:1) health services study in Finland with intake between 2003 and 2007. We estimated sensitivity by the incidence method within one screening round. Overdiagnosis was based on the rate of cervical intraepithelial Grade 3 (CIN3) lesions diagnosed at screen and during the following interval. Out of 203,788 randomised women 132,298 attended (65% in both study arms) and 600,753 person-years accumulated among attenders up to the end of 2010. In all attenders, 34 invasive cervical cancers and 288 CIN3 lesions were diagnosed at screen or during the following interval. The interval cancer incidence was 2.5/105 person-years (sensitivity 0.87) and 1.4 (sensitivity 0.93) in the HPV arm and Pap test arm, respectively. The rate of CIN3 lesions was 57.1 and 38.8, respectively. In conclusion, sensitivity of HPV testing was similar to that of Pap testing but caused more overdiagnosis. Therefore, implementation of HPV testing needs to be reconsidered especially in countries with well organised programmes. What's new? Cervical cancer screeningresults in both benefit for preventing lesions from progressing to invasive cancer and harm for also detecting lesions that would never have led to invasive cancers. This randomised study compares the HPV test to the traditional Pap test in terms of sensitivity (detection of progressive lesions) and overdiagnosis (detection of non-progressive lesions).While the HPV test is known to detect a higher number of pre-invasive lesions, the authors found that sensitivity was high with both tests but overdiagnosis more common with the HPV test, suggesting the need to reconsider the implementation of HPV testing.