HPV screening, invasive cervical cancer and screening policy in Australia

Abstract

The new cervical screening policy in Australia replaces 2-yearly cytology with 5-yearly human papillomavirus (HPV) screening. However, 2 of 5 randomized trials that have reported the number of women with cervical cancer found the incidence rate of invasive cervical cancer during follow-up to be higher for HPV compared with cytology screening. Therefore, we have estimated the possible impact of the new policy on cervical cancer incidence in Australia. Available estimates of the relative protection from cytology screening, estimates of the coverage of the 2-yearly cytology screening policy of the Australian national cervical screening program, and estimates of screening test sensitivity were used to estimate the change in the incidence of cervical cancer from the introduction of the new policy. HPV screening 5-yearly was predicted to increase the annual incidence of cervical cancer in women screened to 121% (95% CI: 73%-169%) of current incidence after 10 years. The overall incidence of cervical cancer in Australia was predicted to increase by 39.2% (95% CI: 34.0%-44.4%) with an additional 222 women developing cervical cancer each year after 10 years. Measures of the screening sensitivity of HPV testing and cervical cytology suggest the introduction of 5-yearly HPV primary screening may increase the incidence cervical cancer in Australia.