In human papillomavirus (HPV) screening, a repeat HPV test is often recommended after positive HPV and normal cytology (HPV-pos/cyt-neg) but its absolute risk of cervical precancer (CIN3+) over two screening rounds needs to be assessed.
We assessed the five-year risk of HPV infection and CIN3+ in HPV-pos/cyt-neg women with a negative repeat HPV test and in double negatives (negative HPV and cytology) in the POBASCAM cohort. We obtained histology data from the Dutch pathology registry (PALGA).
HPV infection risk was 20.4% (19/93) in HPV-pos/cyt-neg, repeat HPV-negative women and 3.2% (294/9,185;p<0.001) in double negatives. Corresponding CIN3+ risks were 2.0% (4/199) and 0.2% (41/18,549,p<0.001). Infection risks were also increased in type-specific analyses of HPV16,31,33,39,52,56 and 58.
HPV-pos/cyt-neg women continue to have an increased CIN3+ risk, also when the repeat HPV test is negative. Therefore, intervals in primary HPV screening should be determined separately for HPV-positive and -negative women.