Primary HPV testing with cytology versus cytology alone in cervical screening-A prospective randomized controlled trial with two rounds of screening in a Chinese population.

We conducted a prospective randomized controlled trial with two screening rounds to evaluate the effectiveness of combining HPV testing with liquid-based cytology (LBC) as a co-test, compared to LBC only in cervical cancer screening of a Chinese population. First, 15,955 women aged 30-60 were randomized at a 1:1 ratio into an intervention group (Digene Hybrid Capture 2 HPV test with LBC) and a control group (LBC alone). Women in the intervention group would be referred for colposcopy and biopsy immediately if they were found to have high-risk HPV regardless of cytology results. The detection of cervical intraepithelial neoplasia grade 2 or above (CIN2+) lesions was significantly higher in the intervention group compared to the control (0.95% vs. 0.38%, OR 2.50, 95% CI 1.65-3.88). At the subsequent round of screening approximately 36 months later, CIN2+ detection was significantly lower in the intervention group (0.08% vs. 0.35%, OR 0.23, 95% CI 0.08-0.57). Over the two rounds of screening, the total detection of CIN2+ was higher in the intervention group (1.01% vs. 0.66%, OR 1.53, 95% CI 1.09-2.19). There was a fourfold increase (10.6% vs. 2.4%, p < 0.001) in the number of colposcopies performed in the intervention arm. Adding a high-risk HPV test to cytology for primary cervical screening led to earlier detection of clinically significant preinvasive lesions, resulting in a reduced detection of CIN2+ lesions in subsequent rounds and an increased rate of colposcopy.

Patient compliance with cervical smear surveillance in a shared-care setting.

OBJECTIVE: To examine patient compliance with cervical smear surveillance at a primary care center. METHODS: A retrospective study included data from patients referred from a tertiary center, to a University of Hong Kong primary care center following colposcopy for continuing cervical smear surveillance between January 1, 2005 and December 31, 2006. Patient records were reviewed and details of the initial screening or treatment that led to referral and the three subsequent follow-up screenings were examined. A multivariate analysis was performed to identify factors that were associated with increased odds of patients not attending follow-up screening. RESULTS: In total, records from 833 patients were included. Of these patients, 348 (41.8%) failed to attend at least one screening, with 172 (49.4%) of this group attending after being reminded. The compliance rate prior to patients being reminded of screening follow-up decreased across the three follow-up screenings, with 706 (84.8%) patients attending their first follow-up visit and 561 (67.3%) patients attending the third. In the multivariate analysis, being younger than 50years old, having a history of smoking, and not having undergone medical treatment related to cervical cancer screening previously were associated with increased odds of not attending follow-up screening (all P<0.05). CONCLUSION: Patients at increased risk of non-compliance with screening follow-up should receive particular attention and counselling regarding screening.