Five-year cervical (pre)cancer risk of women screened by HPV and cytology testing
Menée aux Pays-Bas auprès de 25 553 femmes ayant participé à un programme de dépistage du cancer du col de l'utérus comportant un test de recherche du papillomavirus humain et une analyse cytologique, cette étude évalue, en fonction des différents profils de résultats observés, le risque de lésions cancéreuses ou précancéreuses à 5 ans
Primary human papillomavirus (HPV)-based cervical screening will be introduced in The Netherlands in 2016. We assessed the five-year cervical (pre)cancer risk of women with different combinations of HPV- and cytology test results. Special attention was paid to risks for cervical intraepithelial neoplasia grade 3 and 2 or more (CIN3+/2+) of HPV-positive women with a negative triage-test, since this determines the safety of a five year screenings interval for HPV-positive, triage test negative women. In addition, age-related effects were studied. 25,553 women were screened by HPV-testing and cytology in a screening-setting. Women were managed on presence of HPV and/or abnormal cytology. Five-year cumulative incidences for CIN3+/2+ were calculated. Five-year CIN3+(2+) risk was 10.0%(17.7%) among HPV-positive women. When stratified by cytology, the CIN3+(CIN2+) risk was 7.9%(12.9%) for women with normal cytology and 22.2%(45.3%) for women with equivocal or mildly abnormal (i.e. BMD) cytology. For HPV-negative women the five-year CIN3+(2+) risk was 0.09%(0.21%). Additional triage of HPV-positive women with normal cytology by repeat-cytology at 12 months showed a five-year CIN3+(2+) risk of 4.1%(7.0%). HPV-non16/18-positive women with normal cytology at baseline had comparable risks of 3.5%(7.9%). HPV-non 16/18-positive women with normal baseline cytology and normal repeat-cytology had a five-year CIN3+ risk of 0.42%. No age-related effects were detected. In conclusion, HPV-positive women with normal cytology and a negative triage test, either repeat-cytology after 12 months or baseline HPV 16/18 genotyping, develop a non-negligible CIN3+ risk over five years. Therefore, extension of the screening interval over five years only seems possible for HPV-screen negative women.
Cancer Prevention Research , résumé, 2015