Bottom Line: Nearly all cervical cancers are associated with persistent cervical infection from cancer-related human papillomavirus (HPV) strains. Testing for HPV alone, or combined with a Pap smear (cytology) for cervical screening, has been associated with increased detection of precancerous lesions compared with Pap smears alone. Some organizations have recommended primary HPV-based cervical cancer screening, while others have called for clinical trials of primary HPV testing alone. This study reports the results of a large randomized clinical trial of about 19,000 women that compared primary HPV testing alone versus Pap test for cervical screening. The study demonstrates that primary HPV testing of women detects precancerous lesions earlier, and more accurately than the Pap test. Furthermore, women who were HPV negative were less likely than women screened by Pap tests to have cervical pre-cancer after four years. More research is needed to understand the long-term outcomes and cost-effectiveness of HPV testing.
Authors: Gina Suzanne Ogilvie, M.D., F.C.F.P., Dr.P.H., University of British Columbia, Vancouver, Canada, and coauthors
Visual Abstract: JAMA is introducing this new feature initially focused on randomized clinical trials. A predictive link to the abstract that will work when the embargo lifts is here .
Related material: The editorial, " Replacing the Pap Test With Screening Based on Human Papillomavirus Assays," by L. Stewart Massad, M.D., Washington University School of Medicine, St. Louis, Missouri, is also available on the For The Media website .
To Learn More: The full study is available on the For The Media website .
(doi:10.1001/jama.2018.7464)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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JAMA