To investigate the efficacy and efficiency of different screening programs along 3 periods of time:
2010-2013: Cytology (conventional or liquid based). HPV in ASCUS.
2014-2015: HPV co-test (cytology + HPV test ). Women aged > 30 years.
2016: Primary HRHPV testing. HPV parcial genotyping 16-18 and reflex testing
The base population in our area is 54,372 women. Trained midwives take screening samples in primary healthcare facilities.
In conventional practice, a referral for colposcopy is based on a cytology result : ASCUS and HPV(+), L-SIL, H-SIL, AGC, HPV 16-18 and negative cytologies at women aged > 30 years, and HPV (+) no 16-18 + 2 consecutive negative cytology results for 2 consecutive years.
HPV determination is performed with Roche cobas® 4800 HPV Test (COBAS).
We assessed CIN outcomes following reflex cytology and HPV genotyping for colposcopy triage.
19893 cytologies (4.72 % pathological) were performed during the period of 2010-2013. The frequency of abnormal results was the following: ASCUS (3.63%), L-SIL (0,91%),AGC (0,025%) and H-SIL (0.15%).
For the 2014-2015 period, 10019 cytologies were performed (4.33% pathological), ASCUS (3.17%), ASC-H (0.08%), L-SIL (0.84%) and H-SIL (0.24%) respectively.
In 2016, 1,565 cytologies were performed (13.23% pathological) ASCUS (9.90%), ASC-H (0.45%), L-SIL (2, 43%) and H-SIL (0.45%)
Over the 2010-2013 periods, 2204 HPV determinations were performed, from which positive results were obtained in 27.08% of the cases. During 2014-2015, 8494 HPV determinations were reported, with 12.05% of the results being positive. 2758 studies were performed in 2016, and 10.88% were positive.
745 biopsies were performed during the period 2010-2016. Between 2010-2013, 233 biopsies were performed, (45.37% positive), 58 of them H-SIL. Over 2014-2015 314 biopsies were performed (50,48% positive), 108 H-SIL.
Lastly, in 2016, 198 biopsies were performed (52,33% positive), 69 H-SIL. If we compare the first and the last screening period, positive biopsies increased 241% and H-SIL diagnosis around 375%.
Comparing the first and the last screening period, cytologies have been reduced in a 68.5%, which means a medical cost saving. A big increment is shown in abnormal cytologies during the HPV primary screening.
Closer follow-up of clinical guidelines explains variations in HPV positivity
No benefits are reported from using co-test as first option for the screening program.
A significant increase in the number of colposcopy biopsies was observed over time, with a slight increase in positive biopsy result, but a better diagnosis of H-SIL.
To develop new screening strategy options with the goal of minimizing unnecessary follow-up visits.
Evidence Regarding Human Papillomavirus Testing in Secondary Preventión of Cervical cancer.Marc Arbyn.Guglielmo Ronco.Athi Antttila Vaccine 305 ( 2012) F88-F99