title: Primary high-risk HPV screening for cervical cancer in post-menopausal women.
abstract: OBJECTIVE
  The present study was conducted to examine the value of screening for high-risk HPV in post-menopausal women.
  
  
  METHODS
  A cohort of post-menopausal women (n=2113), age range 55-76 years, from Uppsala County, Sweden, were offered testing for both high-risk HPV and a Pap smear in the gynaecological screening during 2008-2010. For the HPV test the cervical smear sample was applied to a filter paper matrix, an indicating FTA elute card and HPV typing performed using a real-time PCR assay. Histological verified CIN2+ lesion was used as an end-point measurement.
  
  
  RESULTS
  High-risk HPV were found in 6.2% (95% CI 5.2-7.3%) of the women (n=130) and 22% (95% CI 14-32%) (n=17) of these had CIN2+ lesions based on histology. The Pap smear taken in conjunction with the HPV test was abnormal in 9.7% (95% CI 5.7-16.3%) (n=12) of HPV positive women. Among HPV positive women with an abnormal Pap smear, the frequency of histology verified CIN2+ lesions was 67% (95% CI 38-86%) (n=8), as compared to 14% (95% CI 7-24%) (n=9) in HPV positive women with a normal smear. The prevalence of HPV16 in CIN2+ lesions (29%, 95% CI 22-37%) in post-menopausal women was less than half of previous estimates in pre-menopausal women from this population.
  
  
  CONCLUSIONS
  Most histological CIN2+ lesions in post-menopausal women are not recognized by a single Pap smear. A large fraction of pre-invasive cervical cancer cases in post-menopausal women result from infections by HPV types not included in the present vaccine formulas.
authors.affiliation: Department of Immunology, Genetics and Pathology, University of Uppsala, S-751 85 Uppsala, Sweden. ulf.gyllensten@igp.uu.se
authors.forename: Ulf
authors.initials: U
authors.lastname: Gyllensten
authors.forename: Inger
authors.initials: I
authors.lastname: Gustavsson
authors.forename: Monica
authors.initials: M
authors.lastname: Lindell
authors.forename: Erik
authors.initials: E
authors.lastname: Wilander
mesh_terms: D000368:Aged; D052685:Alphapapillomavirus / Q000235:genetics / Q000302:isolation & purification*; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology*; D017698:Postmenopause; D060888:Real-Time Polymerase Chain Reaction; D013548:Sweden / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000821:virology*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000821:virology