The take-home message is that HPV will detect lesions not detected with cytology, but in this LBC trial, the added effect over cytology was small, told lead author Dr. Henry C. Kitchener, from Manchester Academic Health Science Centre. Routine co-testing with HPV and LBC for primary cervical screening is unlikely to be cost effective, and we would not recommend this.

Their current study is not the first to assess the benefit of HPV testing in cervical cancer screening, Dr. Kitchener said. The novel aspect of our trial was that it used LBC. There have been two other similar randomized trials, but they used conventional cytology. LBC is now widely used in developed countries.

The investigators in the ARTISTIC trial involved 24,510 women with 20 to 64 years of age. They were randomized to undergo screening with LBC and HPV testing and the results acted on, or to undergo LBC and HPV screening without revelation of the HPV result. The main outcome measure in the two rounds of screening was the detection rate of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in the second round.

The rate of CIN3+ in the first round of screening was nearly the same in each group, hanging around 1.29%.

The CIN3+ detection rates in the second round fell markedly in both groups, but to a greater extent in the HPV test-revealed group: 0.25% vs. 0.47% (p = 0.042).

But when both the results were combined, the CIN3+ detection rate in the HPV test-revealed group was comparable to that in the control group: 1.51% vs. 1.77% (p > 0.02).

Regarding future research, Dr. Kitchener commented, there are potential advantages of HPV over cytology as a single screening test, for example increased sensitivity and longer screening intervals, so new studies should address the optimal means of using HPV testing in primary cervical screening.