Screening outcome of HPV-vaccinated women: Data from the Danish Trial23 cohort study.

Autor: Nonboe MH; Centre for Health Research, Zealand University Hospital, Nykøbing Falster, Nykøbing Falster, Denmark., Napolitano GM; Department of Public Health, University of Copenhagen, Copenhagen, Denmark., Kann C; Department of Gynaecology, Rigshospitalet, Copenhagen, Denmark., Andersen B; University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark., Bennetsen MH; Department of Pathology, Randers Regional Hospital, Randers, Denmark., Christiansen S; Department of Pathology, Sydvestjysk Hospital, Esbjerg, Denmark., Frandsen AP; Department of Pathology, Aalborg University Hospital, Aalborg, Denmark., Rygaard C; Centre for Health Research, Zealand University Hospital, Nykøbing Falster, Nykøbing Falster, Denmark., Salmani R; Department of Pathology, Zealand University Hospital, Roskilde, Roskilde, Denmark., Schroll JB; Department of Gynaecology and Obstetrics, Herlev Gentofte University Hospital, Herlev, Denmark.; Center for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, University of Southern Denmark, Odense, Denmark., Lynge E; Centre for Health Research, Zealand University Hospital, Nykøbing Falster, Nykøbing Falster, Denmark.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Jun 25; Vol. 19 (6), pp. e0306044. Date of Electronic Publication: 2024 Jun 25 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0306044
Abstrakt: Background: Danish women-who were HPV-vaccinated as girls-are now reaching an age where they are invited to cervical cancer screening. Because of their expected lower cervical cancer risk, we must reassess our screening strategies. We analyzed Danish HPV-vaccinated women's outcomes after the first screening test at age 23.
Methods and Findings: Our study was embedded in Danish routine cytology-based screening. We conducted an observational study and included women born in 1994, offered the 4-valent HPV vaccine at age 14, and subsequently invited to screening at age 23. Cervical cytology was used for diagnostics and clinical management. Residual material was HPV tested with Cobas® 4800/6800. The most severe histology diagnosis within 795 days of screening was found through linkage with the Danish National Pathology Register. We calculated the number of women undergoing follow-up (repeated testing and/or colposcopy) per detected cervical intraepithelial neoplasia (CIN2+). A total of 6021 women were screened; 92% were HPV-vaccinated; 12% had abnormal cytology; 35% were high-risk HPV-positive, including 0.9% HPV16/18 positive, and 20% had follow-up. In women that were cytology-abnormal and HPV-positive (Cyt+/HPV+), 610 (98.5%) had been followed up, and 138 CIN2+ cases were diagnosed, resulting in 4.4 (95% CI 3.9-5.2) women undergoing follow-up per detected CIN2+. In contrast to recommendations, 182 (12.2%) cytology-normal and HPV-positive (Cyt-/HPV+) women were followed up within 795 days, and 8 CIN2+ cases were found, resulting in 22.8 (95% CI 13.3-59.3) women undergoing follow-up per detected CIN2+.
Conclusion: Overall, HPV prevalence was high in HPV-vaccinated women, but HPV16/18 had largely disappeared. In the large group of cytology-normal and HPV-positive women, 23 had been followed up per detected CIN2+ case. Our data indicated that primary HPV screening of young HPV-vaccinated women would require very effective triage methods to avoid an excessive follow-up burden.
Trial Registration: Trial registration number: NCT0304955.
Competing Interests: EL and MHN received HPV-DNA test kits for Trial23 from Roche Diagnostics, Switzerland. BA received HPV-DNA test kits from Roche Diagnostics, Switzerland for other studies. This does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors have nothing to declare.
(Copyright: © 2024 Nonboe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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