Histological outcomes in HPV-screened elderly women in Denmark

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  • Gry St-Martin, Nykøbing Falster Hospital, Center for Epidemiological Research, Ejegodvej 63, DK-4800 Nykøbing, Denmark, Denmark
  • Petra Hall Viborg, Frederiksberg Hospital, The Danish Clinical Registries, Aarhus N, Denmark.
  • ,
  • Ane Birgitte Telén Andersen, The Danish Clinical Registries, Aarhus N, Denmark.
  • ,
  • Berit Andersen
  • Jette Christensen, Department of Pathology, Aalborg University Hospital, 9100 Aalborg, Denmark., Denmark
  • Dorthe Ejersbo, Department of Pathology, Lillebælt Hospital, Vejle
  • ,
  • Hanne Nørgaard Heje
  • ,
  • Kirsten Marie Jochumsen, Department of Gynecology and Obstetrics, Odense University Hospital, Odense., Denmark
  • Tonje Johansen
  • ,
  • Lise Grupe Larsen, Department of Pathology, Zealand University Hospital, Naestved, Denmark
  • ,
  • Elsebeth Lynge, Nykøbing Falster Hospital, Center for Epidemiological Research, Ejegodvej 63, DK-4800 Nykøbing, Denmark, Department of Public Health, University of Copenhagen, Copenhagen, Denmark, Denmark
  • Reza Rafiolsadat Serizawa, Department of Pathology, Hvidovre Hospital, Hvidovre, Denmark
  • ,
  • Marianne Waldstrøm, Faculty of Health Sciences, Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark.
Introduction:
Danish women exit cervical cancer screening at age 65 years, but 23% of cervical cancer cases occur beyond this age. In addition, due to gradual implementation of cervical cancer screening, older women are underscreened by today´s standards. A one-time screening with HPV test was therefore offered to Danish women born before 1948.

Methods:
Register based study reporting histology diagnoses and conizations in women found HPV positive in the one-time screening. Number and proportion of women with severe or non-severe histology results were calculated for screened and HPV-positive women by age group or region of residence. Number of women with biopsy and/or conization per case of cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+) or CIN3+ were also calculated by age groups and region.

Results:
4,479 (4.1% of screened women) had positive HPV test. 94% of these had one or more additional tests. 2,785 (62%) of HPV-positive women had histology results, and conization was performed in 1,076 (24% of HPV-positive and 1% of all screened women). HPV positivity and CIN3+ detection varied little between regions, but the proportions of HPV positive women undergoing histology varied between regions from 40% to 86% and the proportion with conization from 13% to 36%. Correspondingly, the number of histologies and conizations per CIN3+ detected varied from 5.9 to 11.2 and 1.8 to 4.7, respectively. In total, 514 CIN2+ (0.47% of screened women, 11% of HPV-positive) and 337 CIN3+ (0.31% of screened women, 7.5% of HPV-positive) were diagnosed, including 37 cervical cancer cases.

Discussion:
HPV screening of insufficiently screened birth cohorts can potentially prevent morbidity and mortality from cervical cancer but longer follow-up is needed to see if cancer incidence declines in the screened women in the coming years. Management strategies differed among regions which influenced the proportions undergoing biopsy/conization.
Original languageEnglish
Article numbere0246902
JournalP L o S One
Volume16
Issue2
Number of pages12
ISSN1932-6203
DOIs
Publication statusPublished - Feb 2021

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