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.
|Number of pages||11|
|Journal||BJOG: An International Journal of Obstetrics and Gynaecology|
|Publication status||Published - Jul 2022|
Bibliographical noteFunding 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.
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.
© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
- Cervical cancer
- human papillomavirus