Organizing the Cervical Cancer Screening with DNA–HPV Testing in a Brazilian City Led to a Short Time Impact on Early–Stage Cancer Detection: A Population–Based Demonstration Study

Abstract

Background: Cervical cancer is a preventable disease and the Brazilian screening is opportunistic without impact. This study aims to evaluate an initiative to organize the screening with DNA–HPV testing replacing the cytology. Methods: This demonstration study considered information from 16 384 DNA–HPV tests for screening in women aged 25–64 years, from Indaiatuba city, between OCT2017–MAR2020. The comparison was 20 384 women screened by cytology between OCT2014–MAR2017. The flowchart indicates the repetition in five years of a negative test. If HPV16 and/or HPV18 positive test refers to colposcopy, and if other 12 pooled high–risk HPV positive with abnormal liquid–based cytology refers to colposcopy too. If cytology negative, repeat HPV test in 12 months. The analyses evaluated coverage, age–group compliance, and cancer detected. Findings: After 30 months working, the coverage projection was more than 80%. The age compliance for the HPV test was 99·25% compared to 77·3% in the cytology program. The HPV test program showed 86·8% of negative tests and 6·3% of colposcopy referrals, with 78% of colposcopies done. The HPV testing program detected 21 women with cervical cancer, mean age of 39·6 years, and 76% of cancer at early–stage, compared to 12 cervical cancer cases detected by cytological screening (p=0·0284), mean age of 49·3 years (p=0·0158), and one case at early–stage (p=0·0014). Interpretation: Organizing the cervical cancer screening with DNA–HPV testing demonstrated high coverage and age compliance in a real–life scenario, with immediate impact on cervical cancer detection at an early stage. Funding: University of Campinas, Indaiatuba City, and Roche Diagnostics. Declaration of Interest: None to declare. Ethical Approval: This study was approved by the research ethics committee of the University of Campinas (number 1045580, May 1, 2015).