(ChemotherapyAdvisor) – A study of 25,871 women has found that the most effective approach for cervical screening is to conduct primary high-risk human papilloma virus (hrHPV) screening and, if positive for grade 3 or worse high-grade cervical intraepithelial neoplasia (CIN3+), repeat cytology, investigators concluded in the British Journal of Cancer February 28.

The study sought to determine how best to use hrHPV testing — which is more sensitive than cytology for detecting CIN3+ — for cervical screening. Women 29–61 years of age enrolled in a population-based cohort study were offered both cytology and hrHPV testing. Repeat testing after one and/or two years was recommended for women who were hrHPV positive with normal cytology. If results indicated abnormal cytology and/or a second hrHPV test was positive, they were referred for colposcopy. The primary outcome measure was CIN3+.

The investigators found that CIN3+ risk in women who were hrHPV-positive with abnormal cytology was 42.2%; those with normal cytology had a much lower risk, 5.22% (95% CI: 3.72–7.91). In women with hrHPV-positive normal cytology, an additional cytology step after one year reduced CIN3+ risk to 1.6% if the repeat test was normal.

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By using this approach, only women with the highest CIN3+ risks would be referred for further tests, reducing unnecessary examinations.