This is the final conclusion of the ATHENA study, a 3-year cohort study conducted among women ≥25 years of age to compare HPV as the primary screening regimen for cervical cancer. A total of 42,209 women were enrolled in the study and were screened for HPV and cytology. Colposcopy was performed for abnormal cytology (≥ASCUS) as well as for HPV-positive results. Women with findings < CIN2+ (which was the primary endpoint of the study) were followed up for 3 years. The cumulative incidence of CIN3+ over 3 years was found to be 0.8% (95% CI, 0.5-1.1%) for cytology-negative women and 0.3% (95% CI, 0.1-0.7%) for HPV-negative women, and 0.3% (95% CI, 0.1-0.7%) for both cytology and HPV-negative women. % CI, 0.1-0.6%). The sensitivity of CIN3+ detection by cytology was 47.8% (95% CI, 41.6-54.1%), while the sensitivity of CIN3+ detection by the mixed screening strategy (cytology between 25-29 years of age and combined cytology and HPV over 30 years of age) was 61.7% (95% CI, 56.0-67.5%) and the sensitivity of CIN3+ detection by the HPV screening strategy sensitivity of 76.1% (95% CI, 70.3-81.8%). The specificity for detecting CIN3+ was 97.1% (95% CI, 96.9-97.2%), 94.6% (95% CI, 94.4-94.8%), and 93.5% (95% CI, 93.3-93.8%) for cytology, mixed screening strategies, and HPV screening strategies, respectively. Although HPV screening detected more CIN3+ cases, this screening strategy required more colposcopies (more than cytologic screening, similar to the number of colposcopies required in the mixed screening strategy). In conclusion, the HPV screening strategy has similar results compared to the mixed screening strategy, but requires fewer screenings.