Primary cervical cancer screening with HPV testing compared with liquid-based cytology: results of round 1 of a randomised controlled trial -- the HPV FOCAL Study

Br J Cancer. 2012 Dec 4;107(12):1917-24. doi: 10.1038/bjc.2012.489. Epub 2012 Nov 20.


Background: Round 1 data of human papillomavirus (HPV) FOCAL, a three-arm, randomised trial, which aims to establish the efficacy of HPV DNA testing as a primary screen for cervical cancer, are presented.

Methods: The three arms are: Control arm - liquid based cytology with atypical squamous cells of unknown significance (ASC-US) triage with hrHPV testing; Intervention Arm - hrHPV at entry with liquid-based cytology (LBC) triage of hrHPV positives, with exit screen at 4 years; Safety check arm - hrHPV at entry with LBC triage of hrHPV positives with exit screen at 2 years.

Results: A total of 6154 women were randomised to the control arm and 12 494 to the HPV arms (intervention and safety check). In the HPV arm, the baseline cervical intraepithelial neoplasia (CIN)2+ and CIN3+ rate was 9.2/1000 (95%CI; 7.4, 10.9) and 4.8/1000 (95%CI; 3.6, 6.1), which increased to 16.1/1000 (95%CI 13.2, 18.9) for CIN2+ and to 8.0/1000 (95%CI; 5.9, 10.0) for CIN3+ after subsequent screening of HPV-DNA-positive/cytology-negative women. Detection rate in the control arm remained unchanged after subsequent screening of ASC-US-positive/hrHPV DNA-negative women at 11.0/1000 for CIN2+ and 5.0/1000 for CIN3+.

Conclusion: After subsequent screening of women who were either hrHPV positive/cytology negative or ASC-US positive/HPV negative, women randomised to the HPV arms had increased CIN2+ detection compared with women randomised to the cytology arm.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Algorithms
  • Alphapapillomavirus / genetics
  • Alphapapillomavirus / isolation & purification*
  • Canada / epidemiology
  • Carcinoma, Squamous Cell / diagnosis
  • Carcinoma, Squamous Cell / virology
  • Colposcopy
  • Cytological Techniques / methods*
  • DNA, Viral / isolation & purification
  • Early Detection of Cancer / methods*
  • Female
  • Humans
  • Mass Screening / methods
  • Middle Aged
  • Papillomavirus Infections / complications*
  • Papillomavirus Infections / diagnosis*
  • Papillomavirus Infections / epidemiology
  • Sexual Partners
  • Uterine Cervical Dysplasia / diagnosis
  • Uterine Cervical Dysplasia / virology
  • Uterine Cervical Neoplasms / diagnosis*
  • Uterine Cervical Neoplasms / epidemiology
  • Uterine Cervical Neoplasms / prevention & control
  • Uterine Cervical Neoplasms / virology*
  • Vaginal Smears


  • DNA, Viral