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Cotesting vs Cytology Alone
Four RCTs (N > 130,000 women) compared screening with cytology alone vs cotesting (cytology in combination with hrHPV testing): the NTCC Phase I trial in Italy, 28,32,34 Swedescreen in Sweden, 36,37 A Randomized Trial in Screening to Improve Cytology (ARTISTIC) in the United Kingdom, 38-40 and the Population-Based Screening Study Amsterdam (POBASCAM) in the Netherlands. 41 In all 4 trials, the cumulative relative ratio of CIN 3+ detection between the 2 strategies (cotesting vs cytology alone) were not statistically significant after 2 rounds of screening. The NTCC Phase I, ARTISTIC, and POBASCAM trials reported 2 rounds of Recommended Site screening at 3- to 5-year intervals, whereas Swedescreen reported 1 round of screening with registry follow-up at 3 years. Two trials (Swedescreen and POBASCAM) reported no difference between screening strategies at 13 to 14 years of follow-up.
These 4 trials reported hrHPV positive rates of 7% to 22% for screening with cotesting; again, rates were highest among women younger than 30 or 35 years. Colposcopy rates were higher for screening with cotesting than for cytology alone in 2 trials (ARTISTIC and NTCC Phase I) and not reported in the other 2 trials (Swedescreen and POBASCAM). False-positive rates were higher for screening with cotesting in 3 of 4 trials (Swedescreen did not report the false-positive rate for the intervention group).
The ARTISTIC trial also surveyed a subsample of patients (N = 2508) about the psychological effects of screening. 42 It found no difference in distress or anxiety between women screened with cotesting and women screened with cytology alone. Weiterlesen
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