Long-term protection of HPV test in women at risk of cervical cancer

PLoS One. 2020 Aug 27;15(8):e0237988. doi: 10.1371/journal.pone.0237988. eCollection 2020.


Objective: To evaluate the 9-year incidence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and cumulative adherence to perform a next test in a cohort of women aged 40+ years with no cervical screening cytology within a window of 5 years (underscreened women), after baseline cervical cytology and HPV tests.

Methods: In Catalonia, Spain, co-testing with cytology and HPV test has been recommended in the Public Health system since 2006 for underscreened women. In 2007, 1,594 women with underscreened criteria were identified and followed through medical records form Pathological Department. 9-year cumulative incidence of histologically confirmed CIN2+ and cumulative adherence to perform a next test were estimated using Kaplan-Meier statistics.

Results: Follow-up was available for 1,009 women (63.3%) resulting in 23 women with. CIN2+ (2.3%). Of them, 4 women (17%) had both tests negative at baseline (3CIN2 and 1CIN3) with cumulative incidence of CIN2+ of 0.4% (95% CI: 0.1-1.4) at 5-years and 1.3% (95% CI: 0.4-3.7) at 9-years. During the first year, the prevalence among women with both tests positive was 27.0% (95% CI: 13.0-50.6) for CIN2+. Lost to follow-up was higher among women with both tests negative compared to those with both positive tests (38.7% vs 4.2%, p-value <0.001). 40.5% of the women HPV-/cyto- had a re-screening test during the 4 years following the baseline, increasing until 53.5% during the 6 years of follow-up.

Conclusions: HPV detection shows a high longitudinal predictive value at 9-year to identify women at risk to develop CIN2+. The data validate a safe extension of the 3-year screening intervals (current screening interval) to 5-year intervals in underscreened women that had negative HPV result at baseline. It is necessary to establish mechanisms to ensure screening participation and adequate follow-up for these women.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cohort Studies
  • Early Detection of Cancer
  • Female
  • Follow-Up Studies
  • Humans
  • Mass Screening*
  • Middle Aged
  • Papillomaviridae / isolation & purification*
  • Papillomaviridae / physiology
  • Risk
  • Time Factors
  • Uterine Cervical Neoplasms / diagnosis
  • Uterine Cervical Neoplasms / epidemiology
  • Uterine Cervical Neoplasms / virology*

Grants and funding

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This work was partially supported by grants from: LB: Agència de Gestió d’Ajuts Universitaris i de Recerca of the Government of Catalonia (Grant number 2017 SGR 1718). RI: AEPCC investiga 2016 – Xavier Castellsagué Grant. Finally this study has been funded by Instituto de Salud Carlos III through the project PI16/01254 and CIBERESP CB06/02/0073 (co-funded by FEDER funds/European Regional Development Fund (ERDF), a way to build Europe) and RecerCaixa 2015 (MD088652). We also thank CERCA Programme/Generalitat de Catalunya for institutional support. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.