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    Should HPV screening intervals be extended for some women?


    A Dutch study suggests that extending intervals for human papillomavirus (HPV) testing beyond 5 years—with risk stratification—may be appropriate in some women. Published in BMJ, the findings are from the POBASCAM trial, which reflected 14 years of follow up on HPV- and/or cytology-negative participants.

    The randomized cohort included 43,339 women aged 29 to 61 who were randomly assigned to HPV and cytology co-testing (intervention) or cytology testing alone (control).  The women underwent cervical cancer screening once every 5 years for 3 rounds and were managed based on the test results.

    Related: The latest on HPV prevention

    In the Netherlands, cytological-based cervical cancer screening is offered free to women aged 30 to 60 at 5-year intervals. Beginning in 2017, the interval will be extended to 10 years for HPV-negative women aged ≥40.  Under the current program, the documented cumulative 5-year risk of cervical intraepithelial neoplasia (CIN) 3+ after a negative screen is <1%. In other countries, such as Australia, Italy, New Zealand, and UK, women are screened every 2 to 3 years and there the interval is being expanded to 5 or 7 years.

    The Dutch investigators looked at cumulative incidence of cervical cancer and CIN grade 3 or worse (CIN3+) and estimated in HPV-positive women reductions in CIN3+ incidence after negative cytology, HPV type 16/18 genotyping, and/or repeat cytology. They found that the cumulative incidence of CIN3+ among HPV-negative women was similar to that in women with negative cytology who had undergone 2 rounds of screening (0.09% and 0.69%, respectively). Cervical cancer and CIN3+ risk ratios were 0.97 (95% confidence interval [CI] 0.41 to 2.31, P=0.95) and 0.62 to 1.09, P=0.17) in the two groups, respectively.

    In HPV-negative women aged ≥40, compared with younger women, CIN3+ incidence was 72.2% lower (95% CI 61.6% to 79.9%, P<0.01). There was no significant association between cervical cancer incidence and age. In HPV-positive women with negative cytology, HPV 16/18 genotyping, and/or repeat cytology, CIN3+ incidence was 10.4 times higher than among HPV-negative women (95% CI 5.9 to 18.4).

    The authors concluded that the low long-term incidences of cervical cancer and CIN3+ among HPV-negative women who were studied support extension of the cervical cancer screening interval beyond 5 years in women aged ≥40. Risk stratification should be incorporated into HPV-based programs with intervals >5 years, they said, because of the finding that risk of CIN3+ is at least fivefold higher in HPV-positive women with subsequent negative cytology HPV16/18 genotyping, and/or repeat cytology than in HPV-negative women. 

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    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.
    Miranda Hester
    Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.


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