A cervical screening initiative for elderly women in Denmark

Abstract

Introduction To assess outcome of a one‐time human papillomavirus (HPV)‐screening in 2017 of Danish women aged 70+. Material and methods Women born 1947 or before were personally invited to have a cell‐sample collected by their general practitioner. Screening‐ and follow‐up samples were analyzed in hospital laboratories in the five Danish regions and registered centrally. Follow‐up procedures varied slightly across regions. Cervical intraepithelial neoplasia 2 (CIN2) was recommended treatment threshold. Data were retrieved from the Danish Quality Database for Cervical Cancer Screening. We calculated CIN2+ and CIN3+ detection rates per 1000 screened women, and number of biopsies and conizations per detected CIN2+ case. We tabulated annual number of incident cervical cancer cases in Denmark for the years 2009–2020. Results In total, 359 763 women were invited of whom 108 585 (30% of invited) were screened; 4479 (4.1% of screened, and 4.3% of screened 70–74 years) tested HPV‐positive; of whom 2419 (54% of HPV‐positive) were recommended follow‐up with colposcopy, biopsy and cervical sampling, and 2060 with cell‐sample follow‐up. In total, 2888 women had histology; of whom 1237 cone specimen and 1651 biopsy only. Out of 1000 screened women 11 (95% confidence interval [CI]: 11–12) had conization. In total, 579 women had CIN2+; 209 CIN2, 314 CIN3, and 56 cancer. Out of 1000 screened women five (95% CI: 5–6) had CIN2+. Detection rate of CIN2+ was highest in regions where conization was used as part of first‐line follow‐up. In 2009–2016, number of incident cervical cancers in women aged 70+ in Denmark fluctuated around 64; in 2017 it reached 83 cases; and by 2021 the number had decreased to 50. Conclusions The prevalence of high‐risk HPV of 4.3% in women aged 70–74 is in agreement with data from Australia, and the detection of five CIN+2 cases per 1000 screened women is in agreement with data for 65–69 year old women in Norway. Data are thus starting to accumulate on primary HPV‐screening of elderly women. The screening resulted in a prevalence peak in incident cervical cancers, and it will therefore take some years before the cancer preventive effect of the screening can be evaluated.