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 screening at 3- to 5-year intervals, whereas Swedescreen reported 1 round of screening with registry follow-up at 3 years.