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

Authors:
Alexander Luyten
Alexander Luyten
Hannover Medical School
Germany
Rafael Mikolajczyk
Rafael Mikolajczyk
School of Public Health
College Park | United States
Karl Ulrich Petry
Karl Ulrich Petry
Klinikum der Universität Rostock AOR

Br J Cancer 2019 May 16;120(10):1015-1022. Epub 2019 Apr 16.

Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany.

Background: Randomised controlled trials showed human papillomavirus (HPV)-based screening leads to a significant reduction in cervical cancer incidence compared with cytology-based screening only.

Methods: Non-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.

Results: Twenty-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.

Conclusions: The decline in disease rates with 5-yearly co-testing seems mainly attributable to HPV testing since no CIN3+ occurred in HPV-/Pap+ women.

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http://www.nature.com/articles/s41416-019-0453-2
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http://dx.doi.org/10.1038/s41416-019-0453-2DOI Listing
May 2019
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