Impact of repeatedly screening negative on cervical cancer risk
Menée aux Etats-Unis à partir de données portant sur 1,7 million de femmes incluses dans un programme triennal de dépistage du cancer du col de l'utérus comportant un test HPV et une analyse cytologique, cette étude évalue le risque à 5 ans de cancer du col de l'utérus ou de lésions cervicales de type CIN3+ après plusieurs sessions consécutives de dépistage dont les résultats se sont avérés négatifs
Background : We demonstrated that cervical cancer risk following any screening result is lower if there is a known prior negative screening history versus an unknown screening history. We extended these findings to look at how screening performs following repeatedly screening negative.
Methods : Approximately 1.7 million women aged 30-64 years underwent triennial human papillomavirus (HPV) and cytology co-testing from 2003 to 2021. We modeled 5-year risks of cervical intraepithelial neoplasia grade 3 or more severe diagnoses (CIN3+) and invasive cervical cancer for the initial co-test and then successive rounds following negative co-testing. A logistic-Weibull prevalence-incidence model was used to model risks.
Results : HPV test positivity was greater than cytology positivity for only the first co-test and both decreased with each screening round. Diagnostic yields of CIN3+ and cancer declined with each round of screening so that the first screen yielded 8-fold more CIN3+ and invasive cancer than the 5th screen following 4 consecutive negative co-tests. Five-year risks of CIN3+ for positive and negative HPV and cytology results, individually or combined, decreased considerably after the first screen with smaller decreases in each subsequent round. For cancer, we noticed a considerable decrease with the first screen only. Five-year CIN3+ risks were greater for positive HPV or cytology results with a longer antecedent screening interval and younger age at screening (ptrend<0.001).
Conclusion(s) : Triennial screening that includes HPV testing becomes inefficient after a single, and more so after multiple, negative screens. These data support the use of longer screening intervals, especially following negative screen(s).
Journal of the National Cancer Institute , article en libre accès, 2025