November 27, 2017
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Longer cervical cancer screening intervals may be safe after negative HPV tests

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Women with one or more negative cervical co-tests with HPV and cytology screening have a lower risk for cervical cancer; therefore, it may be safe to extend screening intervals to every 5 years or more in these women, according to research published in Annals of Internal Medicine.

“Current U.S. cervical cancer screening and management guidelines do not consider previous screening history, because data on multiple-round HPV and cytology ‘co-testing’ have been unavailable,” Philip E. Castle, PhD, MPH, from the Albert Einstein College of Medicine, and colleagues wrote.

Castle and colleagues conducted an observational cohort study to determine the cervical cancer risk in routine practice after a history of negative co-tests, HPV test or cytology results at 3-year intervals.

The researchers analyzed data of 990,013 women who had one or more co-tests between 2003 and 2014 from Kaiser Permanente Northern California’s integrated health care system to measure the 3- and 5-year risk for cervical intraepithelial neoplasia grade 3, adenocarcinoma in situ and cervical cancer. Among the included women, there was a variation in the number of negative co-tests both overall and within subgroups by either previous co-test results or baseline age.

Results showed that after each successive negative co-test screening round, the 5-year risk for cervical cancer diminished (0.098%, 0.052% and 0.035%). Regardless of the cytology result, the 5-year risk for cervical cancer after an HPV-negative co-test was similar to the performance of a negative co-test for each consecutive screening round (0.114%, 0.061% and 0.041%).

The cervical cancer risk for the cytology-negative co-test declined after each round regardless of the HPV result (0.199%, 0.065% and 0.043%). However, after an HPV-negative co-test result, 3- and 5-year risks were similar.

After the second negative co-test, there were no incidences of interval cervical cancer. As age increased, the independent risk for cervical cancer declined. Future cervical cancer risk was not affected by the duration of time between screening intervals.

The cervical cancer risk was five to six times lower in women aged 50 years or older with three successive negative co-tests than those aged 30 to 39 years who had their first negative co-test.

“To optimize cervical cancer screening by balancing the cancer prevention benefits with the potential harms of overscreening, it will be necessary to consider the effect of a negative screening history on the cervical cancer risk of a negative screen, as presented here, and on an (incident) positive screen, which will be addressed in a companion paper,” Castle and colleagues concluded. “Given the large number of possible screening strategies and combination of results longitudinal as well as integrating important risk modifiers, such as HPV vaccination status, into risk based cervical screening and management, a risk calculator, in the form of a smartphone application, might be helpful, if not necessary, for clinicians to advise women when they need their next screening.” – by Alaina Tedesco

Disclosure: Castle reports receiving cervical screening tests and diagnostics from Roche, BD Biosciences, Cepheid and Arbor Vita at reduced or no cost for research. Please see study for all other authors’ relevant financial disclosures. Ronco and Franceschi report no relevant financial disclosures.