Cervical Cancer Screening: Comparison of Conventional Pap Smear Test, Liquid-Based Cytology, and Human Papillomavirus Testing as Stand-alone or Cotesting Strategies

Abstract Background: Some countries have implemented stand-alone human papillomavirus (HPV) testing while others consider cotesting for cervical cancer screening. We compared both strategies within a population-based study. Methods: The MARZY cohort study was conducted in Germany. Randomly selected women from population registries aged ?30 years (n = 5,275) were invited to screening with Pap smear, liquid-based cytology (LBC, ThinPrep), and HPV (Hybrid Capture2, HC2). Screen-positive participants [ASC-US+ or high-risk HC2 (hrHC2)] random 5% sample of screen-negatives referred colposcopy. Post hoc genotyping by GP5+/6+ PCR-EIA reverse line blotting. Sensitivity, specificity (adjusted verification bias), potential harms, including number colposcopies needed detect 1 precancerous lesion (NNC), calculated. Results: In 2,627 screened women, cytological sensitivities (Pap, LBC: 47%) lower than (95%) PCR (79%) CIN2+. Cotesting demonstrated higher (HC2 cotesting: 99%; 84%), but at the cost specificities (92%–95%) (HC2: 95%; PCR: 94%) (97% 99%). versus showed equivalent relative sensitivity [HC2: 1.06, 95% confidence interval (CI), 1.00–1.21; 1.07, CI, 1.00–1.27]. Relative either test inferior HPV. LBC (both tests: 0.99, 0.99–1.00). NNC highest cotesting. Conclusions: offers no benefit detection over testing, resulting more false positive results colposcopy referrals. Impact: better balance benefits harms See related commentary Wentzensen Clarke, p. 432