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HPV screening for cervical cancer is reaching maturity

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1303 (Published 31 May 2022) Cite this as: BMJ 2022;377:o1303

Linked Research

Extension of cervical screening intervals with primary human papillomavirus testing

  1. Karen Canfell, professor 1,
  2. Megan Smith, associate professor1,
  3. Marion Saville, professor2,
  4. Marc Arbyn, professor3
  1. 1The Daffodil Centre, University of Sydney, A Joint Venture with Cancer Council, Sydney, NSW, Australia
  2. 2The Australian Centre for Prevention of Cervical Cancer, Melbourne, VIC, Australia
  3. 3Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Belgium
  1. Correspondence to: K Canfell Karen.canfell@nswcc.org.au

Programmes will continue to evolve as the risk landscape changes

Several countries have transitioned from cytology based to primary HPV based cervical screening, including the Netherlands, Australia, England, Scotland, and Wales. Increased detection of cervical precancerous cells was seen in the first screening round after the more sensitive HPV test was introduced in populations previously screened only with cytology.123

In a linked paper, Rebolj and colleagues (doi:10.1136/bmj-2021-068776)4 report on the second screening round in the English HPV pilot, involving 1 341 584 women initially screened in 2013-16 and followed up until the end of 2019. The authors found that women younger than 50 years with a negative first round HPV test result were at much lower risk of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in the second round (adjusted odds ratio 0.26, 95% confidence interval 0.23 to 0.30) or interval cancers (adjusted hazard ratio 0.44, 95% confidence interval 0.23 to 0.84) than women testing negative on the basis of cytology. Risk of second round CIN3+ for women who were HPV negative in the first round were even lower in individuals older than 50 years (adjusted odds ratio 0.46, 0.27 to 0.79). These findings provide important data on the effectiveness of HPV screening in relation to incident CIN3+.

In the English Cervical Screening Programme, screening intervals are age dependent, with routine invitations sent at three years for women aged 25-49 years and at five years for women aged 50-64 years. …

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