Human papillomavirus (HPV) screening — compared with cytology-based screening — is associated with higher detection rates for precancerous cervical lesions in a country with high HPV vaccination coverage, suggests a PLOS Medicine study.

Australian researchers randomised 5000 women aged 25 to 64 years presenting for cervical screening to liquid-based cytology or HPV screening. Women undergoing HPV screening were referred directly for colposcopy if HPV-16 or 18 was detected, and they underwent either liquid-based or dual-stained cytology triage for other high-risk HPV types. Nearly a quarter of participants had been eligible for HPV vaccination based on age.

After adjustment for vaccination age eligibility, the colposcopy referral rate was similar across the groups (roughly 3%). However, the rate of detected high-grade precancer (CIN2+) was significantly higher with HPV screening than with cytology (roughly 1.0% vs. 0.1%).

The authors conclude: "These findings provide initial support for the implementation of primary HPV screening in vaccinated populations."