O‐2 “ARTISTIC” TRIAL: BASELINE DATA

Abstract

Objectives: A randomised trial in screening to improve cytology (ARTISTIC Trial) was set up to evaluate the effectiveness of human papilloma virus (HPV) testing in primary cervical screening.Design: Women attending the NHS Cervical Screening Programme in Greater Manchester were screened for HPV in addition to routine cytological testing with ThinPrep Liquid‐Based Cytology (LBC). 25 020 women aged 20–64 were screened at entry and 3 years later. Participants were randomised in a 3 : 1 ratio between those whose HPV test result was revealed and acted upon and those in whom it was concealed.Results: A total of 24 510 women (18 386 revealed and 6124 concealed) had adequate cytology and HPV results. Cytology results at entry were: 87% normal, 11% borderline or mild, 1.1% moderate and 0.6% severe dyskaryosis or worse. Prevalence of HPV decreased sharply with age, from 40% at age 20–24 to 12% at 35–39 and 7% or less above age 50, and increased with cytological grade, from 10% (normal cytology) to 31% (borderline), 70% (mild), 86% (moderate), and 96% (severe or worse). Only 60% of women with severe dyskaryosis showed HPV 16 and / or 18 infection.Conclusion: The ARTISTIC Trial has provided the largest collection of LBC samples with HPV typing in Greater Manchester population. It has shown that the HPV testing is practicable in routine screening in women aged over 30. HPV 16 and 18 are more predictive for underlying disease, but other HPV types account for 30% of high‐grade disease.