Naucler P et al. (2007) Human papillomavirus and Papanicolaou tests to screen for cervical cancer. N Eng J Med 357: 1589–1597

Cervical screening by the Papanicolaou (Pap) test substantially reduces the incidence of invasive cervical cancer, but this cancer continues to be a major cause of death in women. Combined Pap and human papillomavirus (HPV) testing might be better than the Pap test alone to detect grade 3 cervical intraepithelial neoplasia, a known precursor of invasive cervical cancer. Naucler et al. carried out a population-based, randomized, controlled trial in women aged 32–38 years to test this hypothesis.

A total of 12,527 women underwent HPV plus Pap testing or a Pap test only. Women with a positive HPV and normal Pap results were offered another HPV test at least 1 year later. If persistent infection was present women were offered colposcopy with cervical biopsy.

During the 4-year follow-up, grade 2 or 3 cervical intraepithelial neoplasia or cancer was 51% more common among women who underwent both tests than among those who were tested by Pap alone. At subsequent screenings, risk of grade 2 or 3 lesion in the group initially given both tests was reduced by more than 40%, compared with women who had only Pap smears.

The authors conclude that use of a combined HPV and Pap test to screen women in their mid-30s for cervical cancer might enable intervals between testing to be extended. Longer intervals could lead to lower costs, and possibly reduce mortality among women who attend for screening less frequently than currently recommended.