Randomized implementation of a primary human papillomavirus testing-based cervical cancer screening protocol for women 34 to 69 years in Norway
Nygård, Mari; Engesæter, Birgit Øvstebø; Castle, Philip E.; Berland, Jannicke; Eide, Maj Liv; Iversen, Ole-Erik; Jonassen, Christine M; Christiansen, Irene Kraus; Vintermyr, Olav Karsten; Trope, Ameli
Journal article, Peer reviewed
Published version
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https://hdl.handle.net/11250/3022883Utgivelsesdato
2022Metadata
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- Department of Clinical Science [2379]
- Registrations from Cristin [10237]
Originalversjon
Cancer Epidemiology, Biomarkers and Prevention. 2022, 31 (9), 1812-1822. 10.1158/1055-9965.EPI-22-0340Sammendrag
Background:
Cervical cancer screening programs are facing a programmatic shift where screening protocol based on human papillomavirus testing (HPV-Screening protocol) is replacing the liquid-based cytology (LBC-Screening protocol). For safe technology transfer within the nationwide screening programme in Norway, HPV-Screening protocol was implemented randomized to compare the real-world effectiveness of HPV-Screening protocol and LBC-Screening protocol at the first screening round.
Methods:
Among 302,295 women ages 34 to 69 years scheduled to attend screening from February 2015 to June 2017, 157,447 attended. A total of 77,207 were randomly allocated to the HPV-Screening protocol and 80,240 were allocated to the LBC-Screening protocol. All women were followed up for 18 months.
Results:
The HPV-Screening protocol resulted in a relative increase of 60% in the detection of cervical intraepithelial neoplasia (CIN) grade 2 or worse [risk ratio (RR) = 1.6, 95% confidence interval (CI) = 1.5–1.7], 40% in CIN grade 3 or worse (RR = 1.4, 95% CI = 1.3–1.6), 40% in cancer (RR = 1.4, 95% CI = 1.0–2.1), and 60% in colposcopy referrals (RR = 1.6, 95% CI = 1.5–1.6) compared with LBC-Screening. The performance of both protocols was age dependent, being more effective in women ages under 50 years.
Conclusions:
The HPV-Screening protocol was well accepted by women in Norway and detected more CIN2, CIN3, and cancers compared with the LBC-Screening protocol.
Impact:
A randomized implementation of the HPV-Screening protocol with real-world assessment enabled a gradual, quality assured, and safe technology transition. HPV-based screening protocol may further be improved by using HPV genotyping and age-specific referral algorithms.