HPV DNA testing in population-based cervical screening (VUSA-Screen study): results and implications

Area of Science:

• Gynecology
• Oncology
• Public Health

Background:

• Cervical cancer screening relies on cytology, but human papillomavirus (HPV) testing offers higher sensitivity for detecting high-grade cervical intraepithelial neoplasia (CIN).
• Evaluating the performance of high-risk HPV (hrHPV) testing in routine cervical cancer screening is essential.

Purpose of the Study:

• To assess the effectiveness of hrHPV testing in routine cervical cancer screening.
• To stratify women based on their risk for CIN grade 3 or worse (CIN3+).

Main Methods:

• A population-based cohort study involving 25,871 women (aged 29-61) who underwent both cytology and hrHPV testing.
• Follow-up testing and colposcopy referral strategies were implemented based on hrHPV and cytology results, with adjustments for non-attendance.

Main Results:

• hrHPV-positive women with abnormal cytology had a 42.2% CIN3+ risk.
• hrHPV-positive women with normal cytology had a significantly lower CIN3+ risk (5.22%), further reduced to 1.6% with repeat cytology after 1 year.
• Younger women (29-33 years) with hrHPV-positive normal cytology had a higher CIN3+ risk (9.1%) compared to older women (3.0%).

Conclusions:

• Primary hrHPV screening with cytology triage for women aged ≥30 is an effective strategy for CIN3+ risk stratification.
• This approach appears to be a feasible alternative to traditional cytological screening.
• Repeat cytology after one year for hrHPV-positive women with normal cytology is necessary before resuming routine screening.