# Cervical screening with primary HPV testing or cytology in a population of women in which those aged 33 years or younger had previously been offered HPV vaccination: results of the Compass pilot randomised trial

Source: https://onco.cc/key-papers/paper-canfell-compass-pilot-plos-med-2017/  
OnCo record `paper-canfell-compass-pilot-plos-med-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The first randomised test of HPV-based cervical screening in a country that had already vaccinated its young women. HPV testing found more precancer than the smear test did.

## Summary

Compass is an open-label randomised trial of five-yearly HPV screening against two-and-a-half-yearly liquid-based cytology. In its pilot, women aged 25 to 64 attending 47 primary care practices in Victoria between October 2013 and November 2014 were randomised 1:2:2 to cytology with HPV triage of low-grade results, HPV screening with cytology triage, or HPV screening with dual-stained cytology triage; in both HPV arms women positive for HPV16 or 18 went straight to colposcopy. By 2014 resident women aged 33 or younger had been age-eligible for HPV vaccination, with three-dose uptake of about 50 to 77 percent across cohorts.

Of 4,995 women analysed, detected CIN2+ was 1/995 (0.1 percent) with cytology, 20/1,992 (1.0 percent) with HPV and cytology triage and 24/2,008 (1.2 percent) with HPV and dual-stain triage (p = 0.003 for cytology against HPV screening). Colposcopy referral was 2.7, 3.8 and 3.9 percent, a difference that was not statistically significant (p = 0.09).

## Fields

- Kind: Key paper
- Last checked: 2026-11-03
- Journal: PLoS Medicine
- Year: 2017
- DOI: 10.1371/journal.pmed.1002388
- Authors: Canfell K, Caruana M, Gebski V, Darlington-Brown J, Heley S, Brotherton J, Gertig D, Jennett CJ, Farnsworth A, Tan J, Wrede CD, Castle PE, Saville M
- Findings: 4,995 women analysed after 11 withdrawals, from 5,006 recruited at 47 practices in Victoria between 29 October 2013 and 7 November 2014.; Detected CIN2+: 0.1% (1/995) with cytology, 1.0% (20/1,992) with HPV and cytology triage, 1.2% (24/2,008) with HPV and dual-stain triage; p = 0.003 for cytology against HPV screening.; Colposcopy referral: 2.7%, 3.8% and 3.9%; p = 0.09.; No serious trial-related adverse events.
- What it means: It was early randomised evidence that HPV testing still finds more precancer than cytology once a population is partly vaccinated, the question Australia had to answer before changing its national programme to HPV testing every five years.
- Caveats: The authors note a relatively low-risk, previously well-screened population, unknown individual vaccination status, and no long-term follow-up yet of screen-negative women.; This is the pilot; the main Compass trial of 76,181 women is still in follow-up.

## Sources

- PLoS Medicine 2017: https://doi.org/10.1371/journal.pmed.1002388
- PubMed: https://pubmed.ncbi.nlm.nih.gov/28926579/

## Connected records

- cancers: [Cervical cancer](https://onco.cc/cancers/cervical/)
- fronts: [Prevention & Risk](https://onco.cc/fronts/prevention/)
- technologies: [HPV & HBV vaccination](https://onco.cc/technologies/hpv-vaccine/)
- institutions: [Australian Centre for the Prevention of Cervical Cancer](https://onco.cc/institutions/acpcc/)
- trials: [Compass (primary HPV cervical screening trial)](https://onco.cc/trials/compass-cervical-hpv-screening/)
- people: [Karen Canfell](https://onco.cc/people/karen-canfell/)

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