HPV Test Identifies Cervical Precancer Earlier Than Pap

The HPV FOCAL trial published in JAMA found that women who underwent cervical cancer screening with human papillomavirus (HPV) testing had a significantly lower incidence of cervical precancer at 48-month follow-up than women who underwent a Papanicolaou (Pap) test alone.   The randomized study was conducted in an organized Cervical Cancer Screening Program in Canada, and patients (25-65 years) were recruited through 224 collaborating clinicians between January 2008 and May 2012.   Researchers enrolled 19,009 women who were randomized to receive HPV testing (n=9,552) and Pap testing via liquid-based cytology (n=9,457). Women who received HPV testing and had negative results returned at 48 months. Women who received Pap testing and had negative results returned at 24 and, if negative, again 48 months. At 48-months, both groups received HPV and Pap co-testing.  At 48 months, significantly fewer cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) and CIN grade 2 or worse (CIN2+) were detected in the HPV testing group. The CIN3+ incidence rate was 2.3 per 1,000 in the HPV group versus 5.5 per 1,000 in the Pap group (risk ratio [RR] = 0.42). The CIN2+ incidence rate at was 5.0 per 1,000 versus 10.6 per 1,000, respectively (RR=0.47).   Source: JAMA