Long term predictive values of cytology and human papillomavirus testing in cervical cancer screening: joint European cohort study

• Published in: BMJ Vol. 337; no. 7676; pp. 969 - 972
• Main Authors: Dillner, Joakim, Rebolj, Matejka, Birembaut, Philippe, Petry, Karl-Ulrich, Szarewski, Anne, Munk, Christian, de Sanjose, Silvia, Naucler, Pontus, Lloveras, Belen, Kjaer, Susanne, Cuzick, Jack, van Ballegooijen, Marjolein, Clavel, Christine, Iftner, Thomas
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 2008; British Medical Association; BMJ Publishing Group LTD; BMJ Publishing Group; BMJ Publishing Group Ltd
• Edition: International edition
• Subjects: Basic Medicine; Biological and medical sciences; Cancer screening; Cellular biology; Cervical cancer; Cervical intraepithelial neoplasia; Cervical Intraepithelial Neoplasia - diagnosis; Cervical Intraepithelial Neoplasia - epidemiology; Cervical Intraepithelial Neoplasia - virology; Cohort Studies; Colposcopy; Cytological Techniques; Cytology; Europe - epidemiology; Female; Female genital diseases; General aspects; Gynecology. Andrology. Obstetrics; Histology; Human papillomavirus; Humans; Incidence; Kaplan-Meier Estimate; Lesions; Mass Screening; Medical and Health Sciences; Medical sciences; Medical screening; Medicin och hälsovetenskap; Medicinska och farmaceutiska grundvetenskaper; Microbiology in the medical area; Mikrobiologi inom det medicinska området; Papillomavirus Infections - diagnosis; Papillomavirus Infections - epidemiology; Pathology; Polymerase chain reaction; Predictive Value of Tests; Prevention and actions; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Research grants; Screening tests; Studies; Tumors; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - virology; Vaginal Smears; Womens health; Europe; Human; Cytology; Papovaviridae; Malignant tumor; Medical screening; Long term; Female genital diseases; Papillomavirus; Virus; Medicine; Human papillomavirus; Cohort study; Predictive value; Uterine cervix diseases; Cervical cancer; Public health; Cancer
• ISSN: 0959-8138; 0959-8146; 1756-1833; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.a1754

Objective To obtain large scale and generalisable data on the long term predictive value of cytology and human papillomavirus (HPV) testing for development of cervical intraepithelial neoplasia grade 3 or cancer (CIN3+).Design Multinational cohort study with joint database analysis.Setting Seven primary HPV screening studies in six European countries.Participants 24 295 women attending cervical screening enrolled into HPV screening trials who had at least one cervical cytology or histopathology examination during follow-up.Main outcome measure Long term cumulative incidence of CIN3+.Results The cumulative incidence rate of CIN3+ after six years was considerably lower among women negative for HPV at baseline (0.27%, 95% confidence interval 0.12% to 0.45%) than among women with negative results on cytology (0.97%, 0.53% to 1.34%)). By comparison, the cumulative incidence rate for women with negative cytology results at the most commonly recommended screening interval in Europe (three years) was 0.51% (0.23% to 0.77%). The cumulative incidence rate among women with negative cytology results who were positive for HPV increased continuously over time, reaching 10% at six years, whereas the rate among women with positive cytology results who were negative for HPV remained below 3%.Conclusions A consistently low six year cumulative incidence rate of CIN3+ among women negative for HPV suggests that cervical screening strategies in which women are screened for HPV every six years are safe and effective.