Cervical Cancer Screening Interval Extensions Feasible With HPV Testing

Research has shown that tests for human papillomavirus (HPV) are more sensitive than cytology testing for the detection of high-grade cervical intraepithelial neoplasia (CIN).

Researchers in the UK analyzed data to provide updated evidence about the risk of CIN grade 3 or higher (CIN3+) and cervical cancer after a negative HPV test in primary cervical screening. The results of their observational study were published in BMJ.

The study included data from 1,341,584 women, and evaluated 3 specific age ranges: 24 to 49, 50 to 59, and 60 to 64.  

The findings showed incidence of CIN3+ and cervical cancer is approximately 74% lower after a negative HPV screen than after a negative cytology screen in women aged 24 to 49 years, the researchers reported.

They found that the incidence of CIN3+ at subsequent screening after a negative HPV screening test was 50% lower in women aged 50 to 59 than women in the younger age group. They also noted that the differences in detection of CIN3+ and cervical cancer between the different HPV tests were relatively small.

Ultimately, their findings compelled the researchers to recommend extending the 3-year screening interval to 5 years (or more). The English Cervical-Screening Programme has planned on such a 5-year screening interval, they noted.

“Although the difference in the risks between HPV testing and cytology was smaller in women aged 50 and older, the risk at [5] years of CIN3+ after a negative HPV test was halved compared with the risk at [3] years in women younger than 50 years,” they reported. “This finding suggests that the current interval of [5] years at age 50 and older could also be extended.”

The researchers also pointed that a growing number of young women have now been vaccinated against HPV. “Vaccinated women have a substantially lower risk of CIN3+; therefore, routine recall intervals longer than [5] years are highly likely to be safe for these women.”

However, the screening interval should be kept at 3 years for HPV-positive women whose HPV test results are negative at early recall.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Rebolj M, Cuschieri K, Mathews CS, Pesola F, Denton K, Kitchener H; HPV Pilot Steering Group. Extension of cervical screening intervals with primary human papillomavirus testing: observational study of English screening pilot data. BMJ. 2022;377:e068776. doi:10.1136/bmj-2021-068776