Improving Efficiency in Dutch Cervical Screening by Genotyping: An Analysis of Real World Program Data

High-risk human papillomavirus (hrHPV)-genotype specific risk stratification may improve cervical screening efficiency. This study evaluates the risks of cervical intraepithelial neoplasia (CIN), cancer and unnecessary referrals by hrHPV-genotype in cytology-positive (ASCUS+) women, using data from the Dutch population-based cervical screening program. Data from hrHPV+/ASCUS+ women screened between January 2017 and March 2018 were analyzed using the Dutch Screening and Pathology databases. Risks for CIN2+/3+, cancer, and unnecessary referral (i.e., without CIN2+) were evaluated by hrHPV-genotype (HPV16, HPV18, hrHPV-other (i.e., non-16/18 hrHPV), or mixed HPV16/18) using logistic regression, adjusted for age, laboratory (as proxy for region), sampling method (self- vs. clinician sampling), and stratified by age (< 50/≥ 50 years). HPV16+ women had 3.7 (CI: 3.42-3.95) and 4.6 (CI: 4.24-4.99) times higher risks of CIN2+ and CIN3+, respectively, compared to hrHPV-other. HPV18+ women had 1.6 (CI: 1.43-1.79) and 1.9 (CI: 1.68-2.18) times higher risks. The cervical cancer risk was tenfold higher for both HPV16 (OR: 9.85, CI: 6.50-14.95) and HPV18 (OR: 10.27, CI: 6.33-16.68). Women with HPV16 had 70% and HPV18 40% lower risks of unnecessary referral, compared to hrHPV-other. All risk differences between HPV16 or HPV18 and hrHPV-other were statistically significant in both age groups (< 50 and ≥ 50 years). Given the significantly higher risk of CIN2+/3+ and cancer associated with HPV16 and HPV18 and the reduced likelihood of unnecessary referrals compared to hrHPV other, these findings support the use of genotype-based colposcopy referrals in cervical screening to enhance screening efficiency.