title: Cervical cancer screening by cytology and human papillomavirus testing during pregnancy in French women with poor adhesion to regular cervical screening.
abstract: In France, cervical screening is opportunistic and approximately 40% of women do not attend regular screening programs. The aim of this study was (1) to assess the prevalence of human papillomavirus (HPV) cervical infection and of cytological abnormalities in a population of young pregnant women with poor adherence to cervical cancer screening and (2) to evaluate the adherence to a screening strategy combining HPV testing and cytology during pregnancy. For this purpose, pregnant women benefited from a cervical smear associated with HPV DNA detection. High-risk HPV types were detected and identified using the HC2 assay and the INNO-LiPA HPV genotyping Extra assay. Two hundred forty-seven women (mean age 26.6 ± 5.1 years) were enrolled. Among them, 76.8% did not attend regular cervical cancer screening programs. High-risk HPV types were detected in 50 (20.2%) samples, HPV 16 being the most frequent (N = 12; 14.5%), with multiple HPV infection in 17 samples (27%). Nine (3.6%) abnormal cervical smears were diagnosed. Follow-up of women with abnormal cytology and/or infection with high-risk HPV was obtained in 29 cases (55.8%), showing 12 persistent high-risk HPV infections. Nine women had colposcopy with a final diagnosis of four normal cervixes, three cervical intraepithelial neoplasia grade 1 and two cervical intraepithelial neoplasia grade 2. Overall, women adherence to the free post-partum follow-up visit was 53.5%. This study suggests that a screening program combining HPV testing with cervical cytology during pregnancy may be one option to target young women with poor adhesion to regular cervical cancer screening.
authors.affiliation: Prenatal Care Center (PMI), Montpellier, France; Department of Gynecology and Obstetrics, CHRU de Montpellier, Montpellier, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Brun-Micaleff
authors.forename: Amandine
authors.initials: A
authors.lastname: Coffy
authors.forename: Valérie
authors.initials: V
authors.lastname: Rey
authors.forename: Marie-Noëlle
authors.initials: MN
authors.lastname: Didelot
authors.forename: Jacques
authors.initials: J
authors.lastname: Combecal
authors.forename: Sylviane
authors.initials: S
authors.lastname: Doutre
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Daurès
authors.forename: Michel
authors.initials: M
authors.lastname: Segondy
authors.forename: Nathalie
authors.initials: N
authors.lastname: Boulle
mesh_terms: D000293:Adolescent; D000328:Adult; D003584:Cytological Techniques / Q000379:methods*; D005260:Female; D005602:France; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000821:virology; D011247:Pregnancy; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D055815:Young Adult
keywords: HPV; cervical cancer; non-attendees; pregnancy; screening