Research has shown that tests for human papillomavirus (HPV) are more sensitive than cytology testing for the detection of high-grade cervical intraepithelial neoplasia (CIN).

Researchers in the UK analyzed data to provide updated evidence about the risk of CIN grade 3 or higher (CIN3+) and cervical cancer after a negative HPV test in primary cervical screening. The results of their observational study were published in BMJ.

The study included data from 1,341,584 women, and evaluated 3 specific age ranges: 24 to 49, 50 to 59, and 60 to 64.

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The incidence of CIN3+ and cervical cancer was approximately 74% lower after a negative HPV screen than after a negative cytology screen in women aged 24 to 49 years, the researchers reported.

They found that the incidence of CIN3+ at subsequent screening after a negative HPV screening test was 50% lower in women aged 50 to 59 than women in the younger age group. The researchers also noted that the differences in detection of CIN3+ and cervical cancer between the different HPV tests were relatively small.

Ultimately, the findings compelled the researchers to recommend extending the 3-year screening interval to 5 years (or more). The English Cervical-Screening Programme has planned on such a 5-year screening interval, they noted.

“Although the difference in the risks between HPV testing and cytology was smaller in women aged 50 and older, the risk at five years of CIN3+ after a negative HPV test was halved compared with the risk at three years in women younger than 50 years,” they reported. “This finding suggests that the current interval of five years at age 50 and older could also be extended.”

The researchers also pointed out that a growing number of young women have now been vaccinated against HPV. “Vaccinated women have a substantially lower risk of CIN3+; therefore, routine recall intervals longer than five years are highly likely to be safe for these women,” the researchers wrote.

However, the screening interval should be kept at 3 years for HPV-positive women whose HPV test results are negative at early recall.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Rebolj M, Cuschieri K, Mathews CS, Pesola F, Denton K, Kitchener H; HPV Pilot Steering Group. Extension of cervical screening intervals with primary human papillomavirus testing: observational study of English screening pilot data. BMJ. 2022;377:e068776. doi:10.1136/bmj-2021-068776

This article originally appeared on Oncology Nurse Advisor