Is human papillomavirus screening effective to decrease cervical cancer rates in women 65 to 69 years of age who have never been screened?
This initial investigation found a small benefit to HPV screening of women ages 65 to 69 years of age without recent HPV testing and were at least 5 years out from their last Pap smear.
Non-randomized controlled trial
This nonrandomized controlled study enrolled all 65- to 69-year-old women in Denmark who had not had either previous human papillomavirus (HPV) testing after age 60 years or cervical cytology screening in the preceding 5.5 years. Women in one region of the country were invited for HPV-based cervical cancer screening and either cervical cytology in an office or via self-sampling. Women in the control group received usual care, which may have included screening. In the 11,192 participants who received HPV screening and received follow-up within the following year (98.4%), 455 (6.5%) were HPV positive and 1.67% [calculated] were HPV16/18 positive. Of the participants who screened positive, 60.4% had histology results obtained and 15.8% of these (95% CI 11.6% - 20.5%) had cervical intraepithelial neoplasia (CIN) grade 2 or worse detected. The percentage of CIN2+ lesions diagnosed among the women with HPV16/18 and positive histology results (17.2%; 10.3 - 26.1%) was higher but not statistically different from the percentage diagnosed among women with other types of HPV (14.8%; 9.9 - 20.9%). These rates were higher than the rates for women who did not receive screening.
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine