Long term predictive values of cytology and human papillomavirus testing in cervical cancer screening: joint European cohort study.
OBJECTIVE
To obtain large scale and generalisable data on the long term predictive value of cytology and human papillomavirus (HPV) testing for development of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+).


METHODS
Multinational cohort study with joint database analysis.


METHODS
Seven primary HPV screening studies in six European countries.


METHODS
24,295 women attending cervical screening enrolled into HPV screening trials who had at least one cervical cytology or histopathology examination during follow-up.


METHODS
Long term cumulative incidence of CIN3+.


RESULTS
The cumulative incidence rate of CIN3+ after six years was considerably lower among women negative for HPV at baseline (0.27%, 95% confidence interval 0.12% to 0.45%) than among women with negative results on cytology (0.97%, 0.53% to 1.34%)). By comparison, the cumulative incidence rate for women with negative cytology results at the most commonly recommended screening interval in Europe (three years) was 0.51% (0.23% to 0.77%). The cumulative incidence rate among women with negative cytology results who were positive for HPV increased continuously over time, reaching 10% at six years, whereas the rate among women with positive cytology results who were negative for HPV remained below 3%.


CONCLUSIONS
A consistently low six year cumulative incidence rate of CIN3+ among women negative for HPV suggests that cervical screening strategies in which women are screened for HPV every six years are safe and effective.
Lund University, Medical Microbiology, University Hospital MAS, 205 02 Malmö, Sweden. joakim.dillner@med.lu.se
Joakim
J
Dillner
Matejka
M
Rebolj
Philippe
P
Birembaut
Karl-Ulrich
KU
Petry
Anne
A
Szarewski
Christian
C
Munk
Silvia
S
de Sanjose
Pontus
P
Naucler
Belen
B
Lloveras
Susanne
S
Kjaer
Jack
J
Cuzick
Marjolein
M
van Ballegooijen
Christine
C
Clavel
Thomas
T
Iftner
D015331:Cohort Studies; D003584:Cytological Techniques; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008403:Mass Screening; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology