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Published on: March 11, 2014
Invasive Cervical Cancer Detection After Transition to Primary Human Papillomavirus Screening: Population-Based
Rita Sousa1, José Alberto Fonseca-Moutinho2, Fábio Gomes3
1Gynecology Department. Instituto Português de Oncologia de Coimbra Francisco Gentil. Coimbra. & NOVA National School of Public Health. Public Health Research Centre, Comprehensive Health Research Center (CHRC, REAL, CCAL). NOVA University Lisbon. Lisbon. Portugal.
The shift to human papillomavirus (HPV) testing for cervical cancer screening increased detection within the organized program. Invasive cervical cancer rates outside screening remained stable, suggesting a pathway shift, not increased disease.
Area of Science:
- Oncology
- Public Health
- Epidemiology
Background:
- Invasive cervical cancer (ICC) is a critical metric for evaluating cervical cancer screening (CCS) program effectiveness.
- Monitoring ICC trends and differentiating screen-detected versus non-screen-detected cancers is vital for assessing program impact, especially during transitions like introducing human papillomavirus (HPV) primary screening.
Purpose of the Study:
- To evaluate the impact of transitioning from cytology-based to HPV-based primary screening on ICC detection rates in Portugal's Central Region.
- To assess changes in ICC incidence within and outside the organized screening program following the implementation of HPV primary screening.
Main Methods:
- A retrospective, population-based study was conducted in Portugal's Central Region from 2014 to 2023.
- Data linkage between the CCS database and hospital morbidity records identified 654 ICC cases.
- Poisson regression models were used to compare incidence rates between the cytology-based (2014-2019) and HPV-based (2020-2023) screening periods.
Main Results:
- The HPV-based screening period showed a significantly higher rate of screen-detected ICC (IRR = 1.94) compared to the cytology-based period.
- ICC incidence outside the organized screening program did not significantly change between the two periods (IRR = 0.94).
- Screening participation remained stable throughout the study period.
Conclusions:
- The transition to HPV-based primary screening appears to shift ICC detection towards the organized screening program.
- There is no evidence of an increase in ICC incidence among women diagnosed outside the organized screening program, suggesting a change in detection pathway.
- Continued integration of screening, hospital, and cancer registry data is crucial for robust CCS policy evaluation.