Reduction of cervical cancer incidence within a primary HPV screening pilot project (WOLPHSCREEN) in Wolfsburg, Germany

Johannes Horn,Alexander Luyten,Axel Reinecke-Lüthge,Rafael Mikolajczyk,Beate Rothe,Agnieszka Denecke,Karl Ulrich Petry

doi:10.1038/s41416-019-0453-2

Abstract

BackgroundRandomised controlled trials showed human papillomavirus (HPV)-based screening leads to a significant reduction in cervical cancer incidence compared with cytology-based screening only.MethodsNon-hysterectomised participants ≥30 years underwent co-testing with Papanicolaou (Pap) smear and HR-HPV testing (Hybrid Capture 2; HC2). Women with normal findings had their next screening round after 5 years, and HC2+ and Pap abnormal cases were immediately referred for colposcopy, while cases with discordant findings had repeat testing after 12 months with referral to colposcopy in cases with persistent positive findings.ResultsTwenty-six thousand six hundred and twenty-four women were recruited between February 2006 and December 2016. Two hundred and seventy-four CIN3+ cases were diagnosed (270 HPV+, 4 HPV−), including 31 invasive cervical cancers (29 HPV+, 2 HPV−). No CIN3+ was detected in HPV− women with abnormal cytology. We observed a significant decline in the 5-year incidence of CIN3+ (from 0.96% [95% CI 0.85–1.09%] to 0.16% [95% CI 0.10–0.25%]; p < 0.0001) and cervical cancer (from 0.10% [95% CI 0.07%–0.15%] to 0.025% [95% CI 0.01–0.08%]; p = 0.01) between the first and subsequent rounds. Approximately 90% (246/274) of CIN3+ cases were diagnosed at first colposcopy.ConclusionsThe decline in disease rates with 5-yearly co-testing seems mainly attributable to HPV testing since no CIN3+ occurred in HPV−/Pap+ women.

Highlights

Randomised controlled trials showed human papillomavirus (HPV)-based screening leads to a significant reduction in cervical cancer incidence compared with cytology-based screening only
707 participants aged
The current analysis with 11 years follow-up shows that co-testing detects approximately 90% of precursor lesions and invasive cervical cancer at first screening leading to a decline in disease rates in subsequent screening rounds

Summary

Introduction

Randomised controlled trials showed human papillomavirus (HPV)-based screening leads to a significant reduction in cervical cancer incidence compared with cytology-based screening only. An important consequence of the higher sensitivity of HPV testing for CIN2+10 is the longer duration of a low-risk period after a negative result, both for high-grade CIN and invasive cancer, enabling safe extension of the intervals between screening episodes.[11,12,13,14] randomised trials demonstrated the superiority of HPV-based screening for women aged ≥30–35 years,[9] there is still little evidence that similar reductions in cervical cancer incidence can be achieved in a real-world setting in unselected women participating in routine screening programmes. The main focus of this analysis is to determine the incidence of cervical cancer diagnosed in the first screening round compared with subsequent rounds

Methods

Results

Conclusion