Population-based primary HPV mRNA cervical screening compared with cytology screening

Area of Science:

• Gynecology
• Oncology
• Public Health

Background:

• Cervical cancer screening is crucial for early detection and prevention.
• Traditional screening relies on cytology, which has limitations.
• Human Papillomavirus (HPV) testing is emerging as a more sensitive primary screening method.

Purpose of the Study:

• To audit the implementation of primary HPV screening using HPV mRNA testing (Aptima) in Sweden.
• To compare the outcomes of primary HPV screening with conventional cytology screening.
• To evaluate the impact of primary HPV screening on cytology assessment rates and colposcopy referrals.

Main Methods:

• Primary HPV screening was implemented for women aged 30-70 in Skåne, Sweden, starting January 2017.
• HPV-positive samples were followed by cytology assessment, with abnormal results leading to colposcopy.
• Cytology results were compared to a historical cohort screened with conventional cytology in 2016.

Main Results:

• HPV was detected in 7.0% of women screened.
• The proportion of ASCUS or worse (ASCUS+) cytology results was similar between primary HPV screening (3.70%) and conventional cytology (3.52%).
• The colposcopy referral rate increased by 54% with primary HPV screening, while cytology assessments decreased by 86%.

Conclusions:

• Primary HPV screening demonstrated comparable efficacy to conventional cytology in detecting abnormal cervical cytology (ASCUS+).
• The introduction of primary HPV screening significantly reduced the number of necessary cytology assessments.
• The study highlights the potential of HPV mRNA testing for efficient cervical cancer screening programs.