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

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).