Objectives To 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.Design 13 year follow-up of the Swedescreen randomised controlled trial of primary HPV screening.Setting Organised cervical screening programme in Sweden.Participants 12 527 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 registration Clinicaltrials.gov NCT00479375. IntroductionCervical screening using cytology has resulted in a noticeable reduction in cervical cancer. However, there are still about 55 000 annual cases of cervical cancer in the European region. 1Infection with oncogenic types of human papillomavirus (HPV) is a necessary risk factor in cervical carcinogenesis 2 and testing for HPV DNA has a higher sensitivity for detection of cervical intraepithelial neoplasia, the precursor lesion of cervical cancer.3-6 Therefore HPV based cervical screening might possibly enable screening programmes with an increased protective effect against cervical cancer. Because HPV infection precedes the development of cervical intraepithelial neoplasia, 7 it is conceivable that HPV based screening could be performed with longer screening intervals, which in turn could result in more cost effective screening. 8Randomised controlled trials of HPV based screening have found that the initial higher detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) is followed by a r...

Background Robust age-specific estimates of anal human papillomavirus (HPV) and high-grade squamous intraepithelial lesions (HSIL) in men can inform anal cancer prevention efforts. We aimed to evaluate the age-specific prevalence of anal HPV, HSIL, and their combination, in men, stratified by HIV status and sexuality. MethodsWe did a systematic review for studies on anal HPV infection in men and a pooled analysis of individuallevel data from eligible studies across four groups: HIV-positive men who have sex with men (MSM), HIV-negative MSM, HIV-positive men who have sex with women (MSW), and HIV-negative MSW. Studies were required to inform on type-specific HPV infection (at least HPV16), detected by use of a PCR-based test from anal swabs, HIV status, sexuality (MSM, including those who have sex with men only or also with women, or MSW), and age. Authors of eligible studies with a sample size of 200 participants or more were invited to share deidentified individual-level data on the above four variables. Authors of studies including 40 or more HIV-positive MSW or 40 or more men from Africa (irrespective of HIV status and sexuality) were also invited to share these data. Pooled estimates of anal high-risk HPV (HR-HPV, including HPV16,

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