+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Safety of extending screening intervals beyond five years in cervical screening programmes with testing for high risk human papillomavirus: 14 year follow-up of population based randomised cohort in the Netherlands



Safety of extending screening intervals beyond five years in cervical screening programmes with testing for high risk human papillomavirus: 14 year follow-up of population based randomised cohort in the Netherlands



Bmj 355: I4924



 To provide an early risk assessment of extending screening intervals beyond five years for a human papillomavirus (HPV) based cervical screening programme in the Netherlands.  14 year follow-up of a population based randomised cohort from the POBASCAM randomised trial.  Organised cervical screening in the Netherlands, based on a programme of three screening rounds (each round done every five years).  43 339 women aged 29-61 years with a negative HPV and/or negative cytology test participating in the POBASCAM trial.  Women randomly assigned to HPV and cytology co-testing (intervention) or cytology testing only (control), and managed accordingly.  Cumulative incidence of cervical cancer and cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+). Associations with age were expressed as incidence rate ratios. In HPV positive women, reductions in CIN3+ incidence after negative cytology, HPV type 16/18 genotyping, and/or repeat cytology were estimated.  The cumulative incidence of cervical cancer (0.09%) and CIN3+ (0.56%) among HPV negative women in the intervention group after three rounds of screening were similar to the cumulative among women with negative cytology in the control group after two rounds (0.09% and 0.69%, respectively). Cervical cancer and CIN3+ risk ratios were 0.97 (95% confidence interval 0.41 to 2.31, P=0.95) and 0.82 (0.62 to 1.09, P=0.17), respectively. CIN3+ incidence was 72.2% (95% confidence interval 61.6% to 79.9%, P<0.001) lower among HPV negative women aged at least 40 years than among younger women. No significant association between cervical cancer incidence and age could be demonstrated. CIN3+ incidence among HPV positive women with negative cytology, HPV 16/18 genotyping, and/or repeat cytology was 10.4 (95% confidence interval 5.9 to 18.4) times higher than among HPV negative women.  Long term incidences of cervical cancer and CIN3+ were low among HPV negative women in this study cohort, and supports an extension of the cervical screening interval beyond five years for women aged 40 years and older. HPV positive women with subsequent negative cytology, HPV16/18 genotyping, and/or repeat cytology have at least a fivefold higher risk of CIN3+ than HPV negative women, indicating that HPV based programmes with long intervals (>five years) should be implemented with risk stratification.Trial registration POBASCAM trial number ISRCTN20781131.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 058803639

Download citation: RISBibTeXText

PMID: 27702796

DOI: 10.1136/bmj.i4924


Related references

Safety of screening with Human papillomavirus testing for cervical cancer at three-year intervals in a high-risk population: experience from the LAMS study. Journal of Medical Screening 15(2): 97, 2008

High-risk human papillomavirus DNA load in a population-based cervical screening cohort in relation to the detection of high-grade cervical intraepithelial neoplasia and cervical cancer. International Journal of Cancer 124(2): 381-386, 2009

Long-term protective effect of high-risk human papillomavirus testing in population-based cervical screening. British Journal of Cancer 92(9): 1800-1802, 2005

Cervical cancer screening using the Cervista high-risk human papillomavirus test: opportunistic screening of a hospital-based population in Fujian province, China. Cancer Management and Research 10: 3227-3235, 2018

Population-based cohort study assessing the efficacy of cervical cytology (Pap smear) and human papillomavirus (HPV) testing as modalities for cervical cancer screening. Japanese Journal of Clinical Oncology 48(5): 495-498, 2018

The clinical effectiveness and cost-effectiveness of primary human papillomavirus cervical screening in England: extended follow-up of the ARTISTIC randomised trial cohort through three screening rounds. Health Technology Assessment 18(23): 1-196, 2014

Use of a high-risk human papillomavirus DNA test as the primary test in a cervical cancer screening programme: a population-based cohort study. Bjog 120(10): 1260-7; Discussion 1267-8, 2013

A 3-year interval is too short for re-screening women testing negative for human papillomavirus: a population-based cohort study. Bjog 124(10): 1585-1593, 2017

High risk human papillomavirus testing: guidelines for use in screening, triage, and follow-up for the prevention and early detection of cervical cancer. Journal of the National Comprehensive Cancer Network 2(6): 589-596, 2004

Patient concerns about human papillomavirus testing and 5-year intervals in routine cervical cancer screening. Obstetrics and Gynecology 125(2): 317-329, 2015

Human Papillomavirus testing in cervical cancer screening A follow-up cohort study. Abstracts of the General Meeting of the American Society for Microbiology 101: 183, 2001

Urine-based human papillomavirus DNA testing as a screening tool for cervical cancer in high-risk women. International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics 124(2): 151-155, 2014

Changes in genotype prevalence of human papillomavirus over 10-year follow-up of a cervical cancer screening cohort. Zhonghua Liu Xing Bing Xue Za Zhi 38(1): 20-25, 2017

Baseline human papillomavirus status of women with abnormal smears in cervical screening: a 5-year follow-up study in The Netherlands. Bjog 114(8): 951-957, 2007

Baseline Human Papillomavirus Status of Women With Abnormal Smears in Cervical Screening: A 5-Year Follow-up Study in the Netherlands. Obstetrical & Gynecological Survey 62(12): 783-784, 2007