Four large, fair-quality RCTs compared cotesting with cytology screening alone in European women aged 30 to 64 years (Table 3) (46–49). These 4 studies included NTCC phase 1, POBASCAM, Swedescreen, and ARTISTIC, and comprised 82 390 participants. In contrast to HPV screening alone, cotesting did not detect more CIN3+ after 2 screening rounds than cytology alone (Table 3). Round-specific screening results were not completely consistent. Generally, cotesting detected relatively more CIN2+ (and sometimes CIN3+) after 1 screening round, compared with cytology alone. Cotesting identified less CIN3+ (and, where reported, cancers) after the second round, tending toward fewer cancers cumulatively. Interpreting these mixed results is complicated by uncertainty about the completeness of outcome ascertainment for cancers and high-grade precancers due to between-trial differences in duration and completeness of follow-up for the entire screened population and screening episode (15); lack of consensus on the appropriate surrogate outcome (15), with possible asymmetry bias due to limited long-term follow-up (1); and screening protocol differences (Table 3 and Appendix Table) between trials and with U.S. practice.
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Correction: Liquid-Based Cytology and Human Papillomavirus Screening for Cervical Cancer. Ann Intern Med. 2012;156:71–72. doi: 10.7326/0003-4819-156-1-201201030-00032
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Published: Ann Intern Med. 2012;156(1_Part_1):71-72.
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