HPV screening for low cervical cancer risk in older women

HPV screening for low cervical cancer risk in older women

Screening for cervical cancer is still beneficial for older women who have not been exposed to HPV vaccine.
Screening for cervical cancer is still beneficial for older women who have not been exposed to HPV vaccine.

In women older than 55 years, a single human papillomavirus (HPV) DNA test leading to a negative diagnosis and routine cytology screening indicate a low residual lifetime risk of cervical cancer Lancet Oncology,1

The researchers developed a transitional model using Canadian health data to estimate the lifetime risk of cervical cancer in women who had not been vaccinated against HPV. A new cohort of 236,564 women (representing about 20% of Canadian women aged 20-24 in 2012) entered the model every year; Successive cohorts entered every 10 years for a definitive age-structured population model of women between 10 and 100 years of age. Cervical cancer status was classified into 7 stages: non-infected, transient, persistent, cervical intraepithelial neoplasia (CIN) 1, CIN2, CIN3, and cervical cancer. HPV infections were modeled in 4 high-risk groups: HPV16 and HPV18; HPV31, HPV33, HPV45, HPV52 and HPV58; HPV35, HPV39, HPV51, HPV56, HPV59, HPV66 and HPV68; and a generic group of other potentially cancerous HPV infections.

To assess the presence of cervical cancer, researchers calculated a baseline scenario based on the actual screening adherence data, showing that 53% to 68% of women aged 20 to 69 years were screened at least once in the last 42 months. The baseline case was compared to the following scenarios: no screening; Perfect check-up (100% of women every 20 years aged 20 to 69, no check-ups in other age groups); and typical screening adherence (screening for age and / or negative screening test). The screening consisted of cytology, HPV test or cytology / HPV co-tests.

The researchers found that the cumulative lifetime risk of cervical cancer for women without screening or vaccination attempts was 1 in 45 in the past. A typical cytological screening woman who stops screening at the age of 55 is predicted to have a cervical carcinoma risk of 1:13, and a woman with a typical cytology check-up to stop screening at the age of 70 will reduce the lifetime risk of cervical cancer on 1 of 160. Perfect compliance with cytological screening at the age of 25 to 69 years will reduce the risk for women without women to 1 in 532 HPV vaccination.

The researchers further predict that women without previous hysterectomy who test HPV DNA negative and stop screening at the age of 55 have a residual cervical carcinoma risk of 1 in 1940). A single negative HPV test in patients who had never been examined resulted in a low risk of cervical cancer after 55 years (1 in 1096). For persons who were 70 years old and had no exit screen test, the remaining lifetime risk for cervical cancer was determined to be 1 to 588. Those who had an exit screen test had a risk of 1 in 1206 after a negative cytology test, 1 after 6525 after a negative HPV test, and 1 in 9550 after a negative co-test for cytology and HPV.

Researchers conclude that "most cervical cancer prevention in later life is due to screening before the age of 55, but ongoing cytological screening by the age of about 75 may still lead to a gradual reduction in cancer risk lead later life. "

In an accompanying press release2 Lead author Talia Malagón, PhD, explains: "Our study does not necessarily suggest that all screening should end at the age of 55, as the benefits of continued screening depend on the type of screening used. In countries still undergoing cytological screening, screening in old age should further reduce the risk of cervical cancer. However, our results suggest that in countries that use HPV testing as part of screening, it is possible to finish the screening earlier than we currently do, assuming that women have a negative HPV test. "

references

  1. Malagón T., Kulasingam S., Mayrand MH, et al. Age at last screening and remaining lifetime risk of cervical cancer in older, unvaccinated, HPV-negative women: a model study [published online November 1, 2018], Lancet Oncol, doi: 10.1016 / S1470-2045 (18) 30587-4
  2. For the new HPV DNA test, the study shows that screening women 55 years of age with a negative test may be of little use [news release], London, United Kingdom: Lancet Oncology, October 31, 2018. Access to November 1, 2018.

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