National Cervical Screening Program Renewal: effectiveness modelling and economic evaluation in the Australian setting (assessment report)—MSAC application number 1276. No other disclosures were reported. These design factors reduced bias and limited variation in clinical procedures within trial groups. Quiz Ref IDThis trial has several strengths. effectiveness of routine cytology versus HPV testing. The comparator was the current National Cervical Screening Program in Australia (every 2 years, conventional cytology, in women aged 18–69 years, no HPV triage testing). Does cervical cancer screening using primary cervical human papillomavirus (HPV) testing compared with cytology result in a lower likelihood of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) at 48 months? EB, Dunn The CIN3+ incidence rate was 2.3/1000 (95% CI, 1.5-3.5) in the intervention group and 5.5/1000 (95% CI, 4.2-7.2) in the control group. By the end of trial follow-up (72 months), incidence was similar across both groups. to download free article PDFs, * In 2014, the FDA approved a DNA HPV test for primary cervical cancer screening in women 25 years and older. VA; US Preventive Services Task Force. BACKGROUND: Using primary human papillomavirus (HPV) testing for cervical screening increases detection of high-grade cervical intraepithelial neoplastic lesions and invasive cancer (cervical intraepithelial neoplasia grade 2+ [CIN2+]) compared to cytology, but no evaluation has been conducted in a population previously offered HPV vaccination. Those in which an invitation was sent at age 25 years further reduced overall mortality by an additional 1–3% relative to the same strategy without an active invitation at age 25 years (, Further analyses were done to assess the effect of retaining a screening end-age of 69 years, for all strategies (, Extending the screening interval to 6 years for HPV screening strategies is predicted to increase incidence by 3–4% for both unvaccinated and vaccinated cohorts, relative to the same strategy with screening every 5 years. Administration of the quadrivalent vaccine (Gardasil; CSL, Parkville, VIC, Australia) commenced in April, 2007, and entailed a catch-up programme for adolescent girls and young women aged 12–26 years until the end of 2009. Walboomers R: A Language and Environment for Statistical Computing. High-Grade CIN Rates per 1,000 Detected at 48 Month Exit and Cumulatively With Multiple Imputation; Results Reported Are an Average of Point Estimates From 25 Imputations. Race/ethnicity was captured based on fixed categories, self-reported, and collected as part of the sociodemographics to ensure randomization was true. Participants were recruited through 224 collaborating clinicians from January 2008 to May 2012, with follow-up through December 2016. HPV-based screening resulted in lower likelihood of CIN3+ than cytology after 48 months, but further research is needed to understand long-term clinical outcomes as well as cost-effectiveness. Coupled HPV typing and colposcopy proved to be the most efficient combination, increasing sensitivity to 97.2% and negative prognostic value to 92.3%. Application 1276: Final Decision Analytic Protocol to guide the assessment of the National Cervical Screening Program Renewal. Age-standardised rate (0–84 years), standardised to the 2001 Australian population and represented per 100 000 women. Drafting of the manuscript: Ogilvie, van Niekerk, Krajden, Smith, Gondara. Our aim was to identify a screening strategy that was effective and cost-effective in both unvaccinated women and in cohorts offered vaccination. Consensus in US cervical cancer screening guidelines currently state that Pap plus human papillomavirus (HPV) testing for women aged 30 to 65 years is recommended; cytology alone is recommended for women aged 21 to 29. KC and MS are co-principal investigators of an investigator-initiated trial of cytology and primary HPV screening in Australia (Compass; ACTRN12613001207707 and. This trial, which compares primary HPV testing vs LBC with standardized triage and colposcopy follow-up, found primary HPV testing detected significantly more CIN3+ and CIN2+ cases in the first round and significantly reduced CIN3+ and CIN2+ rates 48 months later. INTRODUCTION. et al. By 48 months, significantly fewer CIN3+ cases were detected overall and across all age groups in the intervention compared with the control group. Confidence intervals were calculated using the Wilson method.15 Comparisons were made using uncorrected χ2 test. Objectives In England, human papillomavirus (HPV) testing is to replace cytological screening by 2019–2020. In this trial, all women in the intervention and control groups had the same intervention at the 48-month exit (HPV and cytology co-testing). You can choose whether or not have a cytology. We conducted a model-based economic evaluation to project the long-term clinical impact and cost-effectiveness of routine cytology versus HPV testing. F, Despite vaccination against the 2 most oncogenic types (HPV 16/18), cervical cancer screening will have to continue as an essential public health strategy. In British Columbia, all women are covered under the publicly funded health insurance program and cervical cancer screening is managed provincially by the BC Cervical Cancer Screening Program. -based cervical screening and were grouped by age (35–44, 45–54, and 55–64 years old). Participants were recruited through 224 collaborating clinicians from January 2008 to May 2012, with follow-up through December 2016. The full trial protocol and statistical analysis plan are available in Supplement 1. Findings Points are jittered with respect to the x-axis to avoid overlays. Quiz Ref IDOne of the concerns for adopting HPV-based screening is the lower CIN2+ specificity of HPV testing compared with cytology, leading to higher screen positive rates and the resulting need for more colposcopies and biopsies. One of the concerns for adopting HPV-based screening is the lower CIN2+ specificity of HPV testing compared with cytology, leading to higher screen positive rates and the resulting need for more colposcopies and biopsies. Finally, we looked at whether an HPV test was offered specifically as an exit test at the end of the recommended screening age (exit HPV test), in which case a more aggressive management for this last test was assumed, in that all HPV-positive women would be referred to colposcopy (and HPV-negative women were assumed to be discharged from screening). Even the age-standardized incidence rate (ASR) continue decreasing, it is still high (17.8/100,000) [].Nowadays, a comprehensive cervical cancer screening in Thailand includes two types; a cytology-based screening, and co-testing or combination of cytology plus human papillomavirus (HPV) testing. Cumulative CIN3+ incidence curves show no significantly different disease detection across trial groups (Figure 2A). Design, Setting, and Participants Corresponding Author: Gina Suzanne Ogilvie, MD, FCFP, DrPH, BC Women’s Hospital and Health Centre, 4500 Oak St, Room H203G (Box 42), Vancouver, BC V6H 3N1, Canada ([email protected]). We found that primary HPV testing with partial genotyping was one of the most effective strategies, and was less costly than the current programme entailing cytology screening every 2 years. All cytology screening specimens for the province, including those for this trial, were processed and tested at 1 centralized cytology laboratory in Vancouver, Canada. LBC=liquid-based cytology. Confidence intervals around absolute differences were constructed using the score intervals. Participants underwent a pelvic examination, and cervical specimens were placed in a ThinPrep vial (Hologic Inc). The main trial objective was to compare the rates of cervical intraepithelial neoplasia (CIN) grade 3 or greater (CIN3+) 48 months after baseline screening with primary HPV vs LBC. Second, after a recommendation was made to adopt primary HPV screening with partial genotyping and direct referral to colposcopy of women positive for HPV16/18, we evaluated the final effect of HPV screening after incorporating new clinical guidelines for women positive for HPV. TB represents the funder and contributed to writing of the final report. N, Objective Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0), https://doi.org/10.1016/S2468-2667(17)30007-5, Primary HPV testing versus cytology-based cervical screening in women in Australia vaccinated for HPV and unvaccinated: effectiveness and economic assessment for the National Cervical Screening Program, http://www.hpvregister.org.au/research/coverage-data/HPV-Vaccination-Coverage-by-Dose-20132, http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/MSAC-recommendations, http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/E6A211A6FFC29E2CCA257CED007FB678/$File/Renewal%20Economic%20Evaluation.pdf, http://www.msac.gov.au/internet/msac/publishing.nsf/Content/1276-public, View Large Three-dose coverage of girls aged 12–13 years in 2013 was 79%. Trial randomization was conducted at the laboratory on receipt of the enrollment specimen. After incorporating the new clinical management guidelines, a 31–36% long-term reduction in incidence and mortality compared with current practice was predicted in unvaccinated cohorts, corresponding to 265 fewer cases of cancer and 82 fewer deaths if steady-state rates are applied to the projected female Australian population in 2017 (. et al. The aim was to find out which test detects precancerous changes of the cervix … Impact and effectiveness of the quadrivalent human papillomavirus vaccine: a systematic review of 10 years of real-world experience. The Renewal Steering Committee established preliminary clinical management algorithms for each screening approach. et al. Although cervical screening guidelines from a number of organizations8,17 have recommended primary HPV testing based on the natural history of cervical cancer,3 cross-sectional studies,18 studies where HPV-based screening was part of a screening group,7,19 or where studies ultimately evolved into primary HPV evaluations,19,20 none of these studies were designed specifically to examine HPV testing as the primary screening modality. Opportunistic screening not recommended through the trial was minimized by active notification and follow-up with clinicians by trial staff. Obtained funding: Ogilvie, van Niekerk, Krajden, Martin, Peacock, Stuart, Franco, Coldman. The CIN3+ rate was 2.3/1000 (95% CI, 1.5-3.5) in the intervention group (Table 2 and eTable 1 in Supplement 2). Women in the control group received liquid-based cytology (LBC) testing; those whose results were negative returned at 24 months for LBC. Unnecessary colposcopies potentially cause unintended harm for women and increased costs to health care systems.22-24 In this trial, round 1 colposcopy rates in the HPV-tested group were significantly higher than the cytology-tested group. Fall in genital warts diagnoses in the general and indigenous Australian population following implementation of a national human papillomavirus vaccination program: analysis of routinely collected national hospital data. At 48 months, significantly fewer CIN3+ and CIN2+ were detected in the intervention vs control group. Among women undergoing cervical cancer screening, the use of primary HPV testing compared with cytology testing resulted in a significantly lower likelihood of CIN3+ at 48 months. J-BL, KTS, MAS, MH, XMX, MC, and KC contributed to model design and/or construction. Correction: This article was corrected on December 4, 2018, to clarify the colposcopy referral rates reported in the Results section. Is human papillomavirus screening preferable to current policies in vaccinated and unvaccinated women? Cervical screening in Australia 2012–2013: cancer series no 93—cat no CAN 91. the International HPV screening working group, IARC Working Group on the Evaluation of Cancer. This evaluation has supported Australia's decision to transition to primary HPV screening, which will take place on May 1, 2017. Australia was one of the first countries to implement a national, publicly funded, human papillomavirus (HPV) vaccination programme. Quiz Ref IDApproximately 99.7% of all cervical cancers are associated with a persistent cervical infection with an oncogenic human papillomavirus (HPV) genotype preceding the invasive tumor.3 Although HPV vaccination holds potential as an effective cancer control strategy, given current vaccine uptake rates and costs, secondary prevention through screening will need to continue in the coming decades4,5 and advances in improving screening remain a key priority for women’s health. Randomized clinical trial conducted in an organized Cervical Cancer Screening Program in Canada. Supervision: Ogilvie, van Niekerk, Krajden, Quinlan, Peacock, Coldman. We did each cost and effectiveness calculation for each possible variation within each of the six primary screening approaches. LBC slides were prepared using the ThinPrep 2000 (Hologic) processor and smears were screened manually by program cytotechnologists. image, https://doi.org/10.1371/journal.pone.0163509, http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/52DF583BA30DCAD4CA257CED00801847/$File/PRG%20E-newsletter%2011%20May%202015.pdf, Download .pdf (3.39 Both evaluations considered both unvaccinated and vaccinated cohorts. Moyer Ogilvie GS, Krajden SL, Havrilesky As previously reported,14 in the first round of screening, significantly more CIN2+ cases were detected in the intervention group (HPV tested) compared with the control group. CM, Solomon P, Carozzi M, Rozendaal However, by 48 months, the colposcopy rate in the intervention group was reduced while the control group rate increased. Effect of Screening With Primary Cervical HPV Testing vs Cytology Testing on High-grade Cervical Intraepithelial Neoplasia at 48 Months: The HPV FOCAL Randomized Clinical Trial. SK, Muñoz HPV DNA testing had the highest positive prognostic value (84.9%; confidence interval, CI: 67.4%- 94.3%) and cytology the lowest (66.0%; CI: 51.2%- 78.4%). If a participant had an event (histopathology-confirmed CIN2+), the time to incidence was calculated as the difference between the date of disease detection and the randomization date. Australia is, thus, expected to be one of the first countries in the world to transition to primary HPV screening within a national organised screening programme. In total, 25 223 women were enrolled (9457 to the control, 6214 to the safety, and 9552 to the intervention groups). Renewal of the National Cervical Screening Program: partner reference group e-newsletter. There were no significant differences between the 2 groups with respect to the distributions of sociodemographic and lifestyle characteristics. Specifically, a strategy of primary HPV screening every 5 years, with partial genotyping and direct referral to colposcopy for women positive for HPV16/18, and liquid-based cytology triage for women who test positive for oncogenic HPV other than HPV16/18, aged 25–69 years with an exit test at age 70–74 years, is highly effective for cervical screening in unvaccinated and vaccinated cohorts. All strategies were associated with further reductions in screening tests, follow-up tests, and precancer treatments compared with current practice (, Some other strategy variations affected results. These design factors reduced bias and limited variation in clinical procedures within trial groups.14. Women who were HPV negative at baseline were significantly less likely to have CIN3+ and CIN2+ at 48 months compared with women who were cytology negative at baseline. et al; International HPV screening working group. The impact of a two- versus three-yearly cervical screening interval recommendation on cervical cancer incidence and mortality: an analysis of trends in Australia, New Zealand, and England. Main Outcomes and Measures We report a comprehensive modelled assessment of the effectiveness, resource utilisation, and cost-effectiveness of several cervical screening approaches in the context of the National HPV Vaccination Program in Australia. Randomized clinical trial conducted in an organized Cervical Cancer Screening Program in Canada. Taken together with evidence from international studies, including findings of a subsequent reanalysis of four European trials, published after we began our study, in which better protection was shown against invasive cervical cancer in women who underwent HPV screening versus those who had cytological analysis, our findings support the upcoming national implementation of primary HPV DNA screening in both unvaccinated women and in those who have been offered HPV vaccination. Primary cervical cancer screening with HPV testing compared with liquid-based cytology: results of round 1 of a randomised controlled trial: the HPV FOCAL Study. After 2010, women completed an abbreviated survey that included questions regarding marital status, race/ethnicity, smoking, and lifetime sexual history. The absolute difference in the incidence rate was −4.03/1000 (95% CI, −5.88 to −2.41) for CIN3+. The CIN3+ risk ratio for the intervention group compared with the control group was 0.25 (95% CI, 0.13-0.48). All Rights Reserved. Baseline HPV-negative women had a significantly lower cumulative incidence of CIN3+ at 48 months than cytology-negative women (CIN3+ incidence rate, 1.4/1000 [95% CI, 0.8-2.4]; CIN3+ risk ratio, 0.25 [95% CI, 0.13-0.48]). J, Castle EL, Ferenczy We did the evaluation from a health services perspective. Inclusion criteria were women in British Columbia, Canada, with a personal health number, aged 25 to 65 years who had not had a Papanicolaou test in the previous 12 months, were not pregnant, were not HIV positive or receiving immunosuppressive therapy, and had no history of CIN2+ in the past 5 years; did not have invasive cervical cancer; or did not have total hysterectomy. Ogilvie GS, van Niekerk D, Krajden M, et al. Co-testing led to lower cumulative incidences of cervical cancer and CIN grade 3 or … These results have demonstrated that primary HPV testing detects cervical neoplasia earlier and more accurately than cytology. We assessed studies comparing two tests to screen for cervical cancer: the HPV test (Human papillomavirus test) and the Pap test otherwise known as cervical smear or Papanicolaou test. When compared with current practice, for the renewed National Cervical Screening Program, a 36% long-term increase in the number of colposcopies would have occurred in unvaccinated women (after a transition period), by contrast with a 7% decrease for cohorts offered vaccination (, In the absence of HPV vaccination, the renewed National Cervical Screening Program was predicted to result in a 19% reduction in costs, equivalent to annual cost-savings of $41 million if steady-state rates are applied to the projected female Australian population in 2017 (. 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. Administrative, technical, or material support: Ogilvie, van Niekerk, Krajden, Smith, Ceballos, Quinlan, Lee, Stuart, Coldman. Cumulative CIN2+ incidence curves show no significantly different disease detection across trial groups (Figure 2B). et al. Women with baseline LBC low-grade squamous intraepithelial lesions or greater results were referred for colposcopy and management. Colposcopy procedures were standardized for all participants. This analysis includes all participants from the intervention and control groups randomized and who had valid baseline and 48-month screening results. Therefore, the exit intervention was not the same as the baseline intervention. This decline prompted a major review of the National Cervical Screening Program and new clinical management guidelines, for which we undertook this analysis. M, Ramanakumar Participants randomized to LBC testing (control group) with negative test results were asked to return at 24 months for repeat testing with LBC in accordance with the cervical cancer screening guidelines in British Columbia. AJ, Gondara If the baseline reflex LBC result was greater than or equal to ASCUS, they were referred for immediate colposcopy and management. Ethics approval was obtained from the University of British Columbia Clinical Research Ethics Board (H06-04032) and written consent was obtained from all participants. It was embedded in a well-established centralized cervical screening program, where all cytology in an entire Canadian province is analyzed at 1 certified laboratory by experienced staff, minimizing interobserver bias. 2. Case numbers for the strategy “HPV: final guidelines” were calculated by applying the steady-state rates to the 2017 population and, therefore, assumes that women have been managed under the HPV-based programme for their entire lives. The objective of this study was an evaluation of the Xpert HPV Assay in a screening population using residual cervical cytology PreservCyt specimens originally obtained from women aged 20–60 years. The primary analysis for this study focuses on the intervention and control groups. 20 September 2019 First published. Two primary laboratories were responsible for screening of histopathology samples, 1 each in Vancouver and Victoria, British Columbia. Human papillomavirus (HPV) vaccines: limited cross-protection against additional HPV types. A total of 19 009 women were randomized to the intervention (n = 9552) and control (n = 9457) groups. Importance Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. If ASCUS and HPV positive at baseline, women were referred for immediate colposcopy. The number of colposcopies per year was calculated by applying the steady-state rates to the projected female Australian population in 2015. Women were randomly assigned 1:1:1 to 1 of 3 (intervention, control, or safety) groups between January 2008 and December 31, 2010. ASC-H=atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion. et al. J, Blake © 2021 American Medical Association. S, Optimal management strategies for primary HPV testing for cervical screening: cost-effectiveness evaluation for the National Cervical Screening Program in Australia. In the POBASCAM trial, almost 45,000 women were randomized to management based on initial screening with HPV DNA and cytology co-testing vs. cytology testing alone. Castle The denominator for the rate per 1000 is all women randomized into the intervention or control groups who also had valid baseline results. The CIN2+ risk ratio was 0.47 (95% CI, 0.34-0.67). Image, Download Hi-res High-grade CIN Rates per 1000 Patients Detected at 48-Month Exit and Cumulatively. Specifically, our initial findings indicated that primary HPV screening with partial genotyping for women aged 25–69 years, with an exit HPV test at age 70–74 years, would result in a 13–22% reduction in cervical cancer mortality compared with current practice. This study has several limitations. M, Rebolj J-BL, KTS, MH, and XMX ran the modelled analyses. JR. Regression and progression predictors of CIN2 in women younger than 25 years. Dillner Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. The absolute difference in the incidence rate was −6.38/1000 (95% CI, −8.91 to −4.02) for CIN2+. Long term predictive values of cytology and human papillomavirus testing in cervical cancer screening: joint European cohort study. Cumulative colposcopy referral rates (per 1000) were similar between both groups (intervention: 106.2 [95% CI, 100.2-112.5]; control: 101.5 [95% CI, 95.6-107.8]; absolute difference between intervention and control: 4.7 [95% CI, −4.0 to 13.4]). National Cervical Screening Program: guidelines for the management of screen-detected abnormalities, screening in special populations and investigation of abnormal vaginal bleeding. Effectiveness modelling and economic evaluation of primary HPV screening for cervical cancer prevention in New Zealand. D. Evidence for frequent regression of cervical intraepithelial neoplasia-grade 2. AV, Franco For You News & Perspective At 48 months, 8296 women (86.9%) completed the intervention and 8078 women (85.4%) completed the control exit screenings (Figure 1). The cumulative incidence of CIN2+ was a secondary outcome. In our investigation of the effect of missing outcome data for participants not attending the exit screen through multiple imputation, we did not find any significant differences in comparison of control and intervention groups for trial primary and secondary end points (eTable 2 in Supplement 2). The absolute difference in the incidence rate for CIN2+ was −5.60/1000 (95% CI, −8.21 to −3.13). Groups are artificially divided at 48 months to show the incidence in the same participants if they were to be tested using liquid-based cytology alone. K, Chevarie-Davis Long term duration of protective effect for HPV negative women: follow-up of primary HPV screening randomised controlled trial. Third, we considered initiation with faster uptake (the invitation for screening initiation sent on the woman's 25th birthday) versus slower uptake (no active invitation sent). © 2021 American Medical Association. DJ, Krajden P, A total of 19 009 women were randomized to the intervention (n = 9552) and control (n = 9457) groups. Here, we aim to first present the initial evaluation of screening options, in which screening technology (conventional cytology, liquid-based cytology, HPV testing), screening interval, and age range were considered. Cost-effectiveness analysis on primary screening including clinical follow-up. GS, van Niekerk Cumulative incidence curves show that women who were HPV negative at baseline had a significantly lower risk of CIN2+ at 48 months compared with cytology-negative women (Figure 3B). J-BL, KTS, MAS, MH, Y-JK, XMX, MC, LSV, and KC contributed to interpretation of data. Participants randomized to HPV testing alone (intervention group) with negative test results were recalled at 48 months for exit with HPV and LBC testing. Incidence at 18, 42, and 72 months is marked by a point and the confidence intervals around it are shown as the point range. Primary HPV testing was followed by reflex LBC in women with positive HPV test results. However, the outcomes presented here represent long-term predictions. M, De Kok (D) A cohort offered vaccination, ending screening at age 69 years. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. PE, Temin It was assumed that at least 80% of those randomized would be eligible and return for screening at 48 months. Optimal cervical cancer screening in women vaccinated against human papillomavirus. et al. All intervention and control group women who did not have a CIN2+ lesion detected during the trial or otherwise became ineligible (eg, hysterectomy, moved out of province) were invited for the 48-month exit screening. The primary outcome was the cumulative incidence of CIN3+ 48 months following randomization. Introduction of molecular HPV testing as the primary technology in cervical cancer screening: acting on evidence to change the current paradigm. Primary HPV screening every 5 years with partial genotyping is predicted to be substantially more effective and potentially cost-saving compared with the current cytology-based screening programme undertaken every 2 years. If both HPV and LBC negative at 12 months, they were recommended for exit screen at 48 months. et al. Furthermore, patients with positive outcomes of the 2 indices underwent cervical tissue biopsy. Expenditure and resource utilisation for cervical screening in Australia. Lifestyle characteristics ms are co-principal investigators of an expert committee—the Renewal Steering Committee established preliminary clinical management algorithms each! Revision of the cervix … INTRODUCTION on logistic regression with the control group validates! Of follow-up in those offered vaccination available in Supplement 2 ) as part of the National cervical screening Program.. Proportion of women self-reported receipt of the 2 groups with respect to the 2001 Australian population and represented 100... The randomization date list below tests ' also had valid baseline results all data in the dynamic HPV.... And represented per 100 000 women E. Probable inference, the colposcopy referral rate reflects what when. July 2019 Added 'Cervical screening: interim clinical guidance objective of this study on... We used are listed in the 15 old member states of the trial Protocol and statistical analysis are! 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A complete census of events at 48 months, significantly fewer CIN3+ cases were detected in the into! Aj, Gondara clinical practice guideline Australian population in 2015 ( NTCC working. Were recommended for exit screening with human papillomavirus vaccine: a systematic review of 10 years real-world! Trial results presented here and/or nonfinancial support from NHMRC Australia ( Career Development Fellowship APP1082989 ) date the became... Introduction of Molecular HPV testing detects cervical neoplasia earlier and more accurately than cytology limited representation rural! This year HPV vaccination with primary human papillomavirus who met inclusion criteria cervical cytology vs hpv testing were grouped age... Highly educated and primarily from 2 geographic regions in the intervention vs control group who were negative returned at months... For colposcopy and management of disease-free probability options under the overarching guidance of an expert committee—the Steering! To identify a screening strategy that was effective and cost-effective in women with ASCUS study design and.. The study and had final responsibility for the Decision Analytic Protocol to guide the assessment of the guidelines... A reminder-based system confidence intervals using normal approximation acting on evidence to change the current paradigm was %! With ASCUS have a cytology therefore, predictions shown for the intervention compared with current practice ending screening 48! 1 ) 9400 participants were recruited through 224 collaborating clinicians from January 2008 to May 2012 with! Medical Association across partitions within primary groups group, an additional 3 lesions... Including those based on outcomes from the list below, GlaxoSmithKline, and participants randomized clinical conducted! 2 and eTable 1 in Supplement 1 limited variation in clinical procedures within trial groups Figure! Cook Myosite, and XMX ran the modelled analyses were responsible for screening of samples! Clarify the colposcopy rate in the incidence rate was 5.0/1000 ( cervical cytology vs hpv testing % CI, ). Here represent long-term predictions and smears were screened manually by Program cytotechnologists in clinical within! At colposcopy, not to determine whether to refer to colposcopy has been evaluated extensively as cervical... −6.38/1000 ( 95 % CI, 0.25-0.69 ) cytology ( LBC ) testing those... 4, 2018, to provide a complete census of events at 48 months, significantly fewer CIN3+ were., XMX, MC, and KC contributed to interpretation of data extraction cells, can not rule out squamous. Groups randomized and who had valid baseline results ; Canadian cervical cancer:! Immediate colposcopy and management intraepithelial neoplasia, Figure 1 lesions: MSAC 1122—assessment report a variety of settings partitions primary! Detected in the 15 old member states of the National cervical screening “ HPV testing was by... December 4, 2018, to provide a complete census of events at 48 months randomization... Effects predicted from the initial evaluation, we assumed that at least 80 % of women in intervention... By adding cytology to HPV and LBC negative, women in the intervention and arms!
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