Evidence map›Paper›PMID 24435414›Full record

Trial reportBMJ (Clinical research ed.)2014

Long term duration of protective effect for HPV negative women: follow-up of primary HPV screening randomised controlled trial.

K Miriam Elfström, Vitaly Smelov, Anna L V Johansson, Carina Eklund, Pontus Nauclér, Lisen Arnheim-Dahlström, Joakim Dillner

2 registry-linked trialsAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 52 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
52citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00479375 nacompletednot on this map

Randomized Controlled Trial of Human Papillomavirus Testing in Primary Cervical Screening

TypeinterventionalSponsorSkane University HospitalRan1997 to 2007Enrolled12,527ConditionsCervical Cancer, Cervical Intraepithelial NeoplasiaArmsAdding Human Papillomavirus testing to organised cervical screening
NCT02749110 nacompletednot on this mapstarted 2016, after this paper: background citation

Participation in Screening for Cervical Cancer: Interest of a Human Papillomavirus (HPV) Self-sampling Device Provided by the General Practitioner; a Cluster Randomized Clinical Trial

TypeinterventionalSponsorUniversity Hospital, LilleRan2016 to 2021Enrolled308ConditionsMalignant Tumor of Cervix, Cervical Intraepithelial NeoplasiaArmsVaginal self-sampling brush
3 · Its place in the literature

Who cites it

52 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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  6. Assessing 10-Year Safety of a Single Negative HPV Test for Cervical Cancer Screening: Evidence from FOCAL-DECADE Cohort.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2021
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

K Miriam ElfströmDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77 Stockholm, Sweden.
Vitaly Smelov
Anna L V Johansson
Carina Eklund
Pontus Nauclér
Lisen Arnheim-Dahlström
Joakim Dillner

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo assess whether the increased sensitivity of screening for human papillomavirus (HPV) may represent overdiagnosis and to compare the long term duration of protective effect against cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in HPV based and cytology based screening.

design13 year follow-up of the Swedescreen randomised controlled trial of primary HPV screening.

settingOrganised cervical screening programme in Sweden.

participants12,527 women aged 32-38 attending organised screening were enrolled and randomised to HPV and cytology double testing (intervention arm, n=6257) or to cytology only, with samples frozen for future HPV testing (control arm, n=6270).

main outcome measuresCumulative incidence of CIN2+ and CIN3+ (Kaplan Meier curves). Longitudinal test characteristics were calculated for cytology only, HPV testing only, and cytology and HPV testing combined, adjusting for censoring.

resultsThe increased detection of CIN2+ in the intervention arm decreased over time. After six years, the cumulative incidence of CIN3+ was similar in both trial arms, and after 11 years the cumulative incidence of CIN2+ became similar in both arms. The longitudinal sensitivity of cytology for CIN2+ in the control arm at three years was similar to the sensitivity of HPV testing in the intervention arm at five years of follow-up: 85.94% (95% confidence interval 76.85% to 91.84%) v 86.40% (79.21% to 91.37%). The sensitivity of HPV screening for CIN3+after five years was 89.34% (80.10% to 94.58%) and for cytology after three years was 92.02% (80.59% to 96.97%).

conclusionsOver long term follow-up, the cumulative incidence of CIN2+ was the same for HPV screening and for cytology, implying that the increased sensitivity of HPV screening for CIN2+ reflects earlier detection rather than overdiagnosis. The low long term risks of CIN3+ among women who tested negative in HPV screening, support screening intervals of five years for such women.

trial registrationClinicaltrials.gov NCT00479375.

Indexed as

AdultDiagnosis, DifferentialDNA, ViralFemaleFollow-Up StudiesHumansIncidenceMass ScreeningMiddle AgedNeoplasm StagingPapillomaviridaePapillomavirus InfectionsReproducibility of ResultsRetrospective StudiesSwedenUterine Cervical DysplasiaDNA, Viral

Identifiers

PMID24435414
PMCPMC3898575

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.