Comparison of cervical cancer screening strategies incorporating different combinations of cytology, HPV testing, and genotyping for HPV 16/18: Results from the ATHENA HPV study

J. Thomas Cox, Phillip E. Castle, Catherine M. Behrens, Abha Sharma, Thomas C. Wright, Jack Cuzick

Research output: Contribution to journalArticle

102 Scopus citations


Objective: The objective of the study was to compare 9 cervical cancer screening strategies to the current screening standard (cytology with human papillomavirus [HPV] triage of atypical squamous cells of undetermined significance) for the detection of high-grade cervical disease. Study Design: Women (n = 34,254) aged 30 years or older from the Addressing the Need for Advanced HPV Diagnostics (ATHENA) study underwent screening with cytology and HPV testing with simultaneous HPV16/18 genotyping; those with atypical squamous cells of undetermined significance cytology or greater or HPV-positive status were referred for colposcopy. Results: In general, screening strategies that offered greater sensitivity also required more referral to colposcopy. HPV testing was more sensitive than cytology for detection of cervical intraepithelial neoplasia grade 2 or greater, but strategies that depended on cytology for triage of HPV-positive women decreased this sensitivity. Various strategies of cotesting with cytology increased sensitivity but did so by increasing testing. Strategies that included integrated HPV16/18 testing provided more efficient referral to colposcopy. Conclusion: Strategies that maximize detection of women at greatest risk of cervical intraepithelial neoplasia grade 3 or greater by immediate referral to colposcopy, with follow-up testing of women at intermediate risk, maximize the benefits of cervical cancer screening while decreasing the potential harm. Incorporating screening with HPV and triage of HPV-positive women by a combination of genotyping for HPV16/18 and cytology provided a good balance between maximizing sensitivity (benefit) and specificity by limiting the number of colposcopies (potential harm).

Original languageEnglish (US)
Pages (from-to)184.e1-184.e11
JournalAmerican Journal of Obstetrics and Gynecology
Issue number3
StatePublished - Mar 2013



  • Addressing the Need for Advanced HPV Diagnostics
  • atypical squamous cells of undetermined significance
  • cotesting
  • human papillomavirus
  • human papillomavirus 16/18
  • low-grade squamous intraepithelial lesion

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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