Catch-up HPV test offers high predictability for cervical cancer risk in older women

Catch-up HPV test offers high predictability for cervical cancer risk in older women | Image Credit: © arcyto – © arcyto – stock.adobe.com.

A catch-up human papillomavirus (HPV) test may improve cervical cancer prediction in older women, according to a recent study published in PLoS Medicine.

A “catch-up” HPV test may be effective at detecting disease among women aged 65 years and older who have never undergone an HPV test. It is vital for clinicians to reach these women, as UK data has indicated the risk of cervical cancer development at age 65 is 6 times greater in women who have not been screened since age 50 than those sufficiently screened.

Investigators conducted a study to determine if a catch-up HPV screening intervention is associated with increased screening uptake and cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+) detection. The study was conducted in Denmark, where an HPV-DNA exit test has been offered for women aged 60 to 64 years since 2012.

Participants included women aged 65 to 69 years living in Denmark between April 9 and May 8, 2019, not having a cervical cytology sample or screening invitation record within the past 5.5 years or a record of an HPV-exit test at age 60 to 64, not being registered as actively opting out of the screening program, and having no total hysterectomy or cervical amputation record.

Women residing in the Central Denmark Region (CDM) were assigned to an intervention group, while those residing in 1 of 4 other regions were assigned to a reference group. Exclusion criteria included death, emigration, and migration between the intervention and reference regions between inclusion and end of follow-up.

Insufficient screening was defined as 1 or less cervical cytology sample and sufficient screening as 2 or more cervical samples at age 50 to 64. Cervical screening data was obtained from the Danish Pathology Data Bank (DPDB).

In the intervention group, patients were invited to HPV-based cervical cancer screening and were able to schedule an appointment for a clinician-collected cervical sample or receive a self-sampling kit. Reflex cytology was performed on patients with HPV-positive cervical samples.

The usual practice, used in the reference group, included an opportunity to have a clinician collect a cervical sample for women aged 65 to 69 years. The proportion of tested women and the number of CIN2+ lesions detected per 1000 women were the primary outcomes of the analysis.

There were 11,192 women included in the intervention group and 33,387in the reference group for the final analysis. The mean ages of patients in each group were 68.4 and 68.5 years, respectively, and over 76% of women in both groups had received sufficient screening when aged 50 to 64 years.

Testing was performed in 62.2% of the intervention group, with clinician-based sampling undergone by 71.1% of women tested and vaginal self-sampling by 28.9%. The odds of undergoing self-sampling were 52.1% among patients insufficiently tested vs 27.3% among women sufficiently tested.

A record of a cervical sample was reported in 2.2% of the reference group. Of these patients, 81% received HPV testing. 

The rate of patients being HPV-positive was 6.5% for the total intervention group, 8% among vaginal self-samples, and 5.9% among clinician-collected cervical samples.HPV was reported in 11.5% was insufficiently screened women and 6.2% of sufficiently screened women. Four percent of the reference group was HPV-positive.

These results indicated higher CIN2+ detection from an HPV catch-up screening intervention among women aged 65 years and older. Investigators recommended longer follow-up to determine if the intervention reduces cervical cancers and deaths among screened women.

Reference

Tranberg M, Petersen LK, Hammer A, et al. A Danish population-based nonrandomized intervention study. PLoS Med. 2023;20(7):e1004253. doi:10.1371/journal.pmed.1004253