Testing for the presence of DNA from the human papillomavirus (HPV) alongside conventional screening is the best cervical cancer screening option for all women aged 30 years or older, according to scientists from the Netherlands.
They found that HPV testing combined with liquid-based cytology (commonly known as the smear test) is better at detecting the cell changes that lead to cervical cancer earlier and helps prevent more cervical cancer than the smear test alone.
The work, published in the Lancet Oncology, confirms several other studies that have already shown that HPV testing is more sensitive than the smear test at detecting precancerous cell changes.
The study involved 45,000 woman in the Netherlands who attended routine cervical screening.
Women were then randomly assigned to receive either HPV testing and the smear test, or the smear test alone. At the second screening round 5 years later, HPV and smear testing were done on all women.
The study showed that women who were given HPV tests had a lower chance of subsequently developing more serious changes in the cells of their cervix (known as 'grade 3 cervical intraepithelial neoplasia', or CIN3), and cervical cancer, than women who were offered the smear test only during the first round of screening.
The results showed that the combination of smear tests and DNA tests spotted more cases of intermediate (grade 2) changes or worse than smear tests alone.
And follow-on tests conducted five years later found fewer cases of more serious CIN grade 3 changes and cervical cancer in women from the HPV-tested group than those who'd only had the smear test.
The experts also found that HPV testing in women aged 33 and younger had a lower rate of false positive results, which can lead to unnecessary and uncomfortable treatments
Study author Professor Jack Cuzick, a Cancer Research UK epidemiologist based at Queen Mary, University of London, said the study added to the "overwhelming evidence" that including HPV testing in cervical screening programmes would be beneficial.
"Importantly, this is the second study to show that including HPV testing as the main screening method not only improves detection of precancerous changes, but also cuts cancer rates," he added.
"In the UK, HPV testing is only recommended for women whose smear tests have shown borderline or 'low grade' pre-cancerous changes to cervical cells. But based on the latest evidence, the HPV test would be the most effective way to detect cervical abnormalities in all women over 30."
Jessica Harris, Cancer Research UK's health information manager, said: "These results add to previous evidence showing that HPV testing is an effective way of picking up pre-cancerous cervical changes in women over 30.
"But it's important to answer some outstanding questions about how HPV screening could work in the real world, including how best to manage women who receive a positive HPV test result, and what to do for younger women.
"HPV testing has already been added to the national cervical screening programme to help reduce unnecessary and invasive repeat tests. High quality studies like this will help guide screening decisions in the future."