Age-specific outcomes from the first round of HPV screening in unvaccinated women: Observational study from the English cervical screening pilot

the HPV Pilot Steering Group

doi:10.1111/1471-0528.17058

Age-specific outcomes from the first round of HPV screening in unvaccinated women: Observational study from the English cervical screening pilot

the HPV Pilot Steering Group

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Objective: To report detailed age-specific outcomes from the first round of an English pilot studying the implementation of high-risk human papillomavirus (HR-HPV) testing in primary cervical screening. Design: Observational study with screening in 2013–2016, followed by two early recalls and/or colposcopy until the end of 2019. Setting: Six NHS laboratory sites. Population: A total of 1 341 584 women undergoing screening with HR-HPV testing or liquid-based cytology (LBC). Methods: Early recall tests and colposcopies were recommended, depending on the nature of the screening-detected abnormality. Main outcome measures: We reported standard screening process indicators, e.g. proportions with an abnormality, including high-grade cervical intraepithelial neoplasia (CIN2+) or cancer, and the positive predictive value (PPV) of colposcopy for CIN2+, by screening test and age group. Results: Among unvaccinated women screened with HR-HPV testing at age 24–29 years, 26.9% had a positive test and 10.4% were directly referred to colposcopy following cytology triage, with a PPV for CIN2+ of 47%. At 50–64 years of age, these proportions were much lower: 5.3%, 1.2% and 27%, respectively. The proportions of women testing positive for HR-HPV without cytological abnormalities, whose early recall HR-HPV tests returned negative results, were similar across the age spans: 54% at 24–29 years and 55% at 50–64 years. Two-thirds of infections at any age were linked to non-16/18 genotypes. Among women with CIN2, CIN3 or cervical cancer, however, the proportion of non-16/18 infections increased with age. As expected, the detection of abnormalities was lower following screening with LBC. Conclusions: These data provide a reliable reference for future epidemiological studies, including those concerning the effectiveness of HPV vaccination. Tweetable abstract: Data from the English pilot study provide a comprehensive overview of abnormalities detected through HPV screening.

Original language	English
Pages (from-to)	1278-1288
Number of pages	11
Journal	BJOG: An International Journal of Obstetrics and Gynaecology
Volume	129
Issue number	8
DOIs	https://doi.org/10.1111/1471-0528.17058
Publication status	Published - Jul 2022

Bibliographical note

Funding Information:
Public Health England supported the epidemiological evaluation of the HPV pilot (ref. ODR1718_428). MR and CM (partly) were supported by Cancer Research UK (ref. C8162/A27047). FP was supported by Cancer Research UK (ref. C8162/A25356). Public Health England had a role in designing the pilot, in the collection of the data and commented on the article. Cancer Research UK had no role in designing the study, in the collection of the data and in the writing of the article. Access to the data used in this article was facilitated by the Public Health England Office for Data Release. The laboratory data was based on the information collected and quality assured by the Public Health England Population Screening Programmes. The cancer diagnosis data were collated, maintained and quality assured by the National Cancer Registration and Analysis Service and the Public Health England Population Screening Programmes, which are part of Public Health England. This work used data that had been provided by patients and collected by the National Health Service as part of their care and support. Members of the HPV Pilot Steering Group, other than those listed as authors, included (in alphabetical order): Tracey-Louise Appleyard, Margaret Cruickshank, Kay Ellis, Chris Evans, Viki Frew, Thomas Giles, Alastair Gray, Miles Holbrook, Katherine Hunt, Tanya Levine, Emily McBride, David Mesher, Timothy Palmer, Janet Parker, Elizabeth Rimmer, Hazel Rudge Pickard, Alexandra Sargent, David Smith, John Smith, Kate Soldan, Ruth Stubbs, John Tidy, Xenia Tyler and Jo Waller.

Funding Information:
Public Health England supported the epidemiological evaluation of the HPV pilot (ref. ODR1718_428). MR and CM (partly) were supported by Cancer Research UK (ref. C8162/A27047). FP was supported by Cancer Research UK (ref. C8162/A25356). Public Health England had a role in designing the pilot, in the collection of the data and commented on the article. Cancer Research UK had no role in designing the study, in the collection of the data and in the writing of the article.

Publisher Copyright:
© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.

Keywords

Cervical cancer
human papillomavirus
outcomes
screening

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1111/1471-0528.17058

Cite this

@article{024b8f753daa4031b4919c2bc69e0dfc,

title = "Age-specific outcomes from the first round of HPV screening in unvaccinated women: Observational study from the English cervical screening pilot",

abstract = "Objective: To report detailed age-specific outcomes from the first round of an English pilot studying the implementation of high-risk human papillomavirus (HR-HPV) testing in primary cervical screening. Design: Observational study with screening in 2013–2016, followed by two early recalls and/or colposcopy until the end of 2019. Setting: Six NHS laboratory sites. Population: A total of 1 341 584 women undergoing screening with HR-HPV testing or liquid-based cytology (LBC). Methods: Early recall tests and colposcopies were recommended, depending on the nature of the screening-detected abnormality. Main outcome measures: We reported standard screening process indicators, e.g. proportions with an abnormality, including high-grade cervical intraepithelial neoplasia (CIN2+) or cancer, and the positive predictive value (PPV) of colposcopy for CIN2+, by screening test and age group. Results: Among unvaccinated women screened with HR-HPV testing at age 24–29 years, 26.9% had a positive test and 10.4% were directly referred to colposcopy following cytology triage, with a PPV for CIN2+ of 47%. At 50–64 years of age, these proportions were much lower: 5.3%, 1.2% and 27%, respectively. The proportions of women testing positive for HR-HPV without cytological abnormalities, whose early recall HR-HPV tests returned negative results, were similar across the age spans: 54% at 24–29 years and 55% at 50–64 years. Two-thirds of infections at any age were linked to non-16/18 genotypes. Among women with CIN2, CIN3 or cervical cancer, however, the proportion of non-16/18 infections increased with age. As expected, the detection of abnormalities was lower following screening with LBC. Conclusions: These data provide a reliable reference for future epidemiological studies, including those concerning the effectiveness of HPV vaccination. Tweetable abstract: Data from the English pilot study provide a comprehensive overview of abnormalities detected through HPV screening.",

keywords = "Cervical cancer, human papillomavirus, outcomes, screening",

author = "{the HPV Pilot Steering Group} and Matejka Rebolj and Mathews, {Christopher S.} and Francesca Pesola and Kate Cuschieri and Karin Denton and Henry Kitchener and Appleyard, {Tracey Louise} and Margaret Cruickshank and Kay Ellis and Chris Evans and Viki Frew and Thomas Giles and Alastair Gray and Miles Holbrook and Katherine Hunt and Tanya Levine and Emily McBride and David Mesher and Timothy Palmer and Janet Parker and Elizabeth Rimmer and Pickard, {Hazel Rudge} and Alexandra Sargent and David Smith and John Smith and Kate Soldan and Ruth Stubbs and John Tidy and Xenia Tyler and Jo Waller",

note = "Funding Information: Public Health England supported the epidemiological evaluation of the HPV pilot (ref. ODR1718_428). MR and CM (partly) were supported by Cancer Research UK (ref. C8162/A27047). FP was supported by Cancer Research UK (ref. C8162/A25356). Public Health England had a role in designing the pilot, in the collection of the data and commented on the article. Cancer Research UK had no role in designing the study, in the collection of the data and in the writing of the article. Access to the data used in this article was facilitated by the Public Health England Office for Data Release. The laboratory data was based on the information collected and quality assured by the Public Health England Population Screening Programmes. The cancer diagnosis data were collated, maintained and quality assured by the National Cancer Registration and Analysis Service and the Public Health England Population Screening Programmes, which are part of Public Health England. This work used data that had been provided by patients and collected by the National Health Service as part of their care and support. Members of the HPV Pilot Steering Group, other than those listed as authors, included (in alphabetical order): Tracey-Louise Appleyard, Margaret Cruickshank, Kay Ellis, Chris Evans, Viki Frew, Thomas Giles, Alastair Gray, Miles Holbrook, Katherine Hunt, Tanya Levine, Emily McBride, David Mesher, Timothy Palmer, Janet Parker, Elizabeth Rimmer, Hazel Rudge Pickard, Alexandra Sargent, David Smith, John Smith, Kate Soldan, Ruth Stubbs, John Tidy, Xenia Tyler and Jo Waller. Funding Information: Public Health England supported the epidemiological evaluation of the HPV pilot (ref. ODR1718_428). MR and CM (partly) were supported by Cancer Research UK (ref. C8162/A27047). FP was supported by Cancer Research UK (ref. C8162/A25356). Public Health England had a role in designing the pilot, in the collection of the data and commented on the article. Cancer Research UK had no role in designing the study, in the collection of the data and in the writing of the article. Publisher Copyright: {\textcopyright} 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.",

year = "2022",

month = jul,

doi = "10.1111/1471-0528.17058",

language = "English",

volume = "129",

pages = "1278--1288",

journal = "BJOG: An International Journal of Obstetrics and Gynaecology",

issn = "1470-0328",

publisher = "wiley",

number = "8",

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TY - JOUR

T1 - Age-specific outcomes from the first round of HPV screening in unvaccinated women

T2 - Observational study from the English cervical screening pilot

AU - the HPV Pilot Steering Group

AU - Rebolj, Matejka

AU - Mathews, Christopher S.

AU - Pesola, Francesca

AU - Cuschieri, Kate

AU - Denton, Karin

AU - Kitchener, Henry

AU - Appleyard, Tracey Louise

AU - Cruickshank, Margaret

AU - Ellis, Kay

AU - Evans, Chris

AU - Frew, Viki

AU - Giles, Thomas

AU - Gray, Alastair

AU - Holbrook, Miles

AU - Hunt, Katherine

AU - Levine, Tanya

AU - McBride, Emily

AU - Mesher, David

AU - Palmer, Timothy

AU - Parker, Janet

AU - Rimmer, Elizabeth

AU - Pickard, Hazel Rudge

AU - Sargent, Alexandra

AU - Smith, David

AU - Smith, John

AU - Soldan, Kate

AU - Stubbs, Ruth

AU - Tidy, John

AU - Tyler, Xenia

AU - Waller, Jo

N1 - Funding Information: Public Health England supported the epidemiological evaluation of the HPV pilot (ref. ODR1718_428). MR and CM (partly) were supported by Cancer Research UK (ref. C8162/A27047). FP was supported by Cancer Research UK (ref. C8162/A25356). Public Health England had a role in designing the pilot, in the collection of the data and commented on the article. Cancer Research UK had no role in designing the study, in the collection of the data and in the writing of the article. Access to the data used in this article was facilitated by the Public Health England Office for Data Release. The laboratory data was based on the information collected and quality assured by the Public Health England Population Screening Programmes. The cancer diagnosis data were collated, maintained and quality assured by the National Cancer Registration and Analysis Service and the Public Health England Population Screening Programmes, which are part of Public Health England. This work used data that had been provided by patients and collected by the National Health Service as part of their care and support. Members of the HPV Pilot Steering Group, other than those listed as authors, included (in alphabetical order): Tracey-Louise Appleyard, Margaret Cruickshank, Kay Ellis, Chris Evans, Viki Frew, Thomas Giles, Alastair Gray, Miles Holbrook, Katherine Hunt, Tanya Levine, Emily McBride, David Mesher, Timothy Palmer, Janet Parker, Elizabeth Rimmer, Hazel Rudge Pickard, Alexandra Sargent, David Smith, John Smith, Kate Soldan, Ruth Stubbs, John Tidy, Xenia Tyler and Jo Waller. Funding Information: Public Health England supported the epidemiological evaluation of the HPV pilot (ref. ODR1718_428). MR and CM (partly) were supported by Cancer Research UK (ref. C8162/A27047). FP was supported by Cancer Research UK (ref. C8162/A25356). Public Health England had a role in designing the pilot, in the collection of the data and commented on the article. Cancer Research UK had no role in designing the study, in the collection of the data and in the writing of the article. Publisher Copyright: © 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.

PY - 2022/7

Y1 - 2022/7

N2 - Objective: To report detailed age-specific outcomes from the first round of an English pilot studying the implementation of high-risk human papillomavirus (HR-HPV) testing in primary cervical screening. Design: Observational study with screening in 2013–2016, followed by two early recalls and/or colposcopy until the end of 2019. Setting: Six NHS laboratory sites. Population: A total of 1 341 584 women undergoing screening with HR-HPV testing or liquid-based cytology (LBC). Methods: Early recall tests and colposcopies were recommended, depending on the nature of the screening-detected abnormality. Main outcome measures: We reported standard screening process indicators, e.g. proportions with an abnormality, including high-grade cervical intraepithelial neoplasia (CIN2+) or cancer, and the positive predictive value (PPV) of colposcopy for CIN2+, by screening test and age group. Results: Among unvaccinated women screened with HR-HPV testing at age 24–29 years, 26.9% had a positive test and 10.4% were directly referred to colposcopy following cytology triage, with a PPV for CIN2+ of 47%. At 50–64 years of age, these proportions were much lower: 5.3%, 1.2% and 27%, respectively. The proportions of women testing positive for HR-HPV without cytological abnormalities, whose early recall HR-HPV tests returned negative results, were similar across the age spans: 54% at 24–29 years and 55% at 50–64 years. Two-thirds of infections at any age were linked to non-16/18 genotypes. Among women with CIN2, CIN3 or cervical cancer, however, the proportion of non-16/18 infections increased with age. As expected, the detection of abnormalities was lower following screening with LBC. Conclusions: These data provide a reliable reference for future epidemiological studies, including those concerning the effectiveness of HPV vaccination. Tweetable abstract: Data from the English pilot study provide a comprehensive overview of abnormalities detected through HPV screening.

AB - Objective: To report detailed age-specific outcomes from the first round of an English pilot studying the implementation of high-risk human papillomavirus (HR-HPV) testing in primary cervical screening. Design: Observational study with screening in 2013–2016, followed by two early recalls and/or colposcopy until the end of 2019. Setting: Six NHS laboratory sites. Population: A total of 1 341 584 women undergoing screening with HR-HPV testing or liquid-based cytology (LBC). Methods: Early recall tests and colposcopies were recommended, depending on the nature of the screening-detected abnormality. Main outcome measures: We reported standard screening process indicators, e.g. proportions with an abnormality, including high-grade cervical intraepithelial neoplasia (CIN2+) or cancer, and the positive predictive value (PPV) of colposcopy for CIN2+, by screening test and age group. Results: Among unvaccinated women screened with HR-HPV testing at age 24–29 years, 26.9% had a positive test and 10.4% were directly referred to colposcopy following cytology triage, with a PPV for CIN2+ of 47%. At 50–64 years of age, these proportions were much lower: 5.3%, 1.2% and 27%, respectively. The proportions of women testing positive for HR-HPV without cytological abnormalities, whose early recall HR-HPV tests returned negative results, were similar across the age spans: 54% at 24–29 years and 55% at 50–64 years. Two-thirds of infections at any age were linked to non-16/18 genotypes. Among women with CIN2, CIN3 or cervical cancer, however, the proportion of non-16/18 infections increased with age. As expected, the detection of abnormalities was lower following screening with LBC. Conclusions: These data provide a reliable reference for future epidemiological studies, including those concerning the effectiveness of HPV vaccination. Tweetable abstract: Data from the English pilot study provide a comprehensive overview of abnormalities detected through HPV screening.

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KW - human papillomavirus

KW - outcomes

KW - screening

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JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

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ER -

Age-specific outcomes from the first round of HPV screening in unvaccinated women: Observational study from the English cervical screening pilot

Abstract

Bibliographical note

Keywords

UN SDGs

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