Primary human papillomavirus testing versus CO-testing: clinical outcomes in populations with different disease prevalence.

Implementation of primary human papillomavirus (HPV) testing has been slow in the US perhaps due to concerns of decreased sensitivity compared with concurrent HPV and cytology testing (cotesting). We used the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and the Kaiser Permanente of Northern California (KPNC) cohort to quantify potential trade-offs with primary HPV compared with cotesting in four US populations with differing precancer/cancer prevalence. In all settings, cotesting required more lab tests and more colposcopies compared to primary HPV testing. Additional cervical intraepithelial neoplasia grade 3 or cancer (CIN3+) immediately detected from cotesting vs primary HPV decreased with decreasing population-average CIN3+ prevalence, from 71 per 100,000 screened among never/rarely screened individuals in the NBCCEDP (prevalence = 1,212 per 100,000) to 4 per 100,000 screened among individuals with prior HPV-negative results in KPNC (prevalence = 86 per 100,000). These data suggest that cotesting confer an unfavorable benefit-to-harm ratio over primary HPV testing.