The most common clinical screening methods used to prevent cervical cancer are traditional cervical exfoliation cytology and, more recently, cervical human papillomavirus (HPV) testing. Researchers have completed four clinical trials comparing the effectiveness of these two screening methods for the prevention of cervical invasive cancer, but due to the small number of cases in each of the four randomized controlled trials, none of them was sufficient to independently indicate which screening method was more appropriate for the prevention of cervical invasive cancer. Therefore, there is a lack of precise direct comparative assessment of the difference between HPV screening and cytological screening for the prevention of cervical invasive cancer, as well as changes in the efficacy of each preventive tool according to age, cancer stage, morphological characteristics and duration of cancer prevention. A pooled analysis of data from the four clinical trials mentioned above, followed by the incidence of cervical invasive cancer, found that cervical HPV screening was effective in preventing cervical invasive cancer, as published in the February 6, 2014 issue of The Lancet by Dr. Guglielmo Ronco, et al, of the Italian Center for Cancer Epidemiology and Prevention. The study pooled data from four clinical trials in Sweden (Swedescreen), the Netherlands (POBASCAM), England (ARTISTIC) and Italy (NTCC), randomly assigning 176,464 women aged 20 to 64 years to either the HPV screening group (experimental group) or the cytology screening group (control group), with a median follow-up time of 6.5 years ( 1214415 person-years), 107 cases of invasive cervical cancer were detected by linkage of screening, pathology and cancer registry, and the cumulative detection rate and study-adjusted rate ratio of cervical invasive cancer were calculated separately (experimental group vs. control group). Analysis of four clinical trial study flow characteristics Click to view larger study results showed that the detection rate of cervical invasive cancer was similar in the experimental and control groups at the first 2.5 years of follow-up (0.79, 0.46 -1.36), but significantly lower in the experimental group at subsequent times (0.45, 0.25 -0.81). Among women with negative screening results at enrollment, the cumulative detection rates of cervical invasive cancer in the experimental group were 4.6/105 (1.1-12.1) and 8.7/105 (3.3 -18.6) at 3.5 and 5.5 years, respectively; in the control group, the cumulative detection rates of cervical invasive cancer were 15.4/105 (7.9-27.0) and 36/105 ( 23.2-53.5). The incidence rate ratio was not affected by cancer stage but by pathological type and age, with lower rate ratios for cervical adenocarcinoma (0.31,0.14-0.69) than for squamous cell carcinoma (0.78, 0.49-1.25) and the lowest rate ratios for women aged 30-34 years (0.36, 0.14-0.94). The findings suggest that cervical HPV testing every 5 years is more effective than cervical exfoliative cytology every 3 years in preventing the occurrence of cervical invasive cancer, therefore, it is recommended to clinically implement cervical HPV screening for women starting from the age of 30 years, with a minimum testing interval of 5 years, so as to stop the occurrence and development of cancer at an early stage and reduce the incidence of cervical invasive cancer. The cumulative detection rate of cervical invasive cancer in the experimental group compared with the control group Click to view larger image Background Cervical cancer is one of the common malignant tumors in women, and the incidence of cervical cancer has increased and tends to be younger in recent years. Cervical cancer is closely related to HPV infection, and HPV is the only fully identifiable oncogenic virus in human tumorigenesis. More than 130 types have been isolated, and different types cause different clinical manifestations, which can be divided into low-risk and high-risk types. Most infections do not persist and are often suppressed or disappear naturally. Many women with HPV infection do not have clinical symptoms. When HPV infection persists, it can induce the occurrence of cervical intraepithelial neoplasia (CIN), while CIN2 and CIN3 are precancerous lesions of cervical cancer, and the development of cervical cancer is a long-term process. Some studies have shown that the cumulative incidence of cervical cancer (stage II and above) is significantly lower in women who have been screened once compared to those who have never been screened; however, there are insufficient data to support whether HPV testing can be used as an alternative to traditional cervical cytology screening and the difference in the efficacy of the two screening methods for preventing cervical cancer. HPV screening identifies persistent high-grade CIN prior to cytologic detection of the condition, thereby increasing the likelihood of treatment before further lesion progression; in addition, the similarity of results across screening regimens implies that comparisons of cancer prevention efficacy rely primarily on differences in screening instruments rather than screening regimens, providing a strong basis for the feasibility of further pooled analyses of these four clinical trials. Such direct evaluation of the results is essential for universal implementation of cervical HPV screening as a routine test and for determining screening strategies such as the age at which screening should be initiated and the optimal screening interval.