Long term predictive values of cytology and human papillomavirus testing in cervical cancer screening: joint European cohort study

Joakim Dillner, Matejka Rebolj, Philippe Birembaut, Karl-Ulrich Petry, Anne Szarewski, Christian Munk, Silvia de Sanjose, Pontus Naucler, Belen Lloveras, Susanne Kjaer, Jack Cuzick, Marjolein van Ballegooijen, Christine Clavel, Thomas Iftner, Joint European Cohort Study, Michael Menton, Annette Stubner, C Coll, R M Vilamala, M Badia, R Font, F Martinez, A Avecilla, A Ramirez, H Mausbach, F J García, C I Rera, R Bosser, M P Cañadas, P Felipe, R Almirall, M Olivera, J Klaustermeiyer, B G Hansson, W Ryd, A Strand, G Wadell, E Rylander, S Törnberg, C Quereux, O Graesslin, J P Bory, C Pia, M F Poncelet, Joakim Dillner, Matejka Rebolj, Philippe Birembaut, Karl-Ulrich Petry, Anne Szarewski, Christian Munk, Silvia de Sanjose, Pontus Naucler, Belen Lloveras, Susanne Kjaer, Jack Cuzick, Marjolein van Ballegooijen, Christine Clavel, Thomas Iftner, Joint European Cohort Study, Michael Menton, Annette Stubner, C Coll, R M Vilamala, M Badia, R Font, F Martinez, A Avecilla, A Ramirez, H Mausbach, F J García, C I Rera, R Bosser, M P Cañadas, P Felipe, R Almirall, M Olivera, J Klaustermeiyer, B G Hansson, W Ryd, A Strand, G Wadell, E Rylander, S Törnberg, C Quereux, O Graesslin, J P Bory, C Pia, M F Poncelet

Abstract

Objective: To obtain large scale and generalisable data on the long term predictive value of cytology and human papillomavirus (HPV) testing for development of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+).

Design: Multinational cohort study with joint database analysis.

Setting: Seven primary HPV screening studies in six European countries.

Participants: 24,295 women attending cervical screening enrolled into HPV screening trials who had at least one cervical cytology or histopathology examination during follow-up.

Main outcome measure: Long term cumulative incidence of CIN3+.

Results: The cumulative incidence rate of CIN3+ after six years was considerably lower among women negative for HPV at baseline (0.27%, 95% confidence interval 0.12% to 0.45%) than among women with negative results on cytology (0.97%, 0.53% to 1.34%)). By comparison, the cumulative incidence rate for women with negative cytology results at the most commonly recommended screening interval in Europe (three years) was 0.51% (0.23% to 0.77%). The cumulative incidence rate among women with negative cytology results who were positive for HPV increased continuously over time, reaching 10% at six years, whereas the rate among women with positive cytology results who were negative for HPV remained below 3%.

Conclusions: A consistently low six year cumulative incidence rate of CIN3+ among women negative for HPV suggests that cervical screening strategies in which women are screened for HPV every six years are safe and effective.

Conflict of interest statement

Competing interests: K-UP has received speaker’s honorarium from Digene and Roche and research grants from Digene; TI has received speaker’s honorarium from Digene; JC is on the speaker’s bureau of Digene and the advisory board for Roche and has received research grants from Roche; SK is on an advisory board for Merck and has received research grants from Merck and SPMSD; CM has received travel grants from Merck; SdeS has received travel grants from Digene and GSK and research grants from GSK and Merck/Sanofi Pasteur. The Department of Public Health of the Erasmus MC in Rotterdam, Netherlands, has received a research grant from GSK.

Ethical approval: All studies were approved by the ethical review boards in their respective countries.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787181/bin/dilj569939.f1.jpg
Fig 1 Kaplan-Meier plots of cumulative incidence rate for CIN3+ for women according to baseline test results in the first 72 months of follow-up in all seven countries
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787181/bin/dilj569939.f2.jpg
Fig 2 Kaplan-Meier plots of cumulative incidence rate for CIN3+ for women according to baseline test results in first 72 months of follow-up, excluding Denmark and Tübingen
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787181/bin/dilj569939.f3.jpg
Fig 3 Kaplan-Meier plots of cumulative incidence rate for CIN3+ for women according to baseline test reults in first 72 months of follow-up, excluding Denmark and Tübingen
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787181/bin/dilj569939.f4.jpg
Fig 4 Comparison of cumulative incidence rate (95% confidence interval) of CIN3+ at 60 months by country and by baseline test results

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Source: PubMed

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