HPV-prevalence in elderly women in Denmark

Abstract

Aim. In countries like Denmark, cervical cancer incidence is at present relatively high in elderly women, while routine screening stops at age 65 years. On this background, all women aged 69 and above were invited to human papillomavirus (HPV)-screening in Denmark in 2017.Methods. Women were identified from the Central Population Register and personally invited by digital or ordinary mail to have a screening sample taken by their general practitioner. In four regions, samples were tested for high risk (HPV) with the cobas 4800® HPV-assay, and in the last region with the BD Onclarity® HPV-assay. Participation rate, prevalence of high risk HPV, and proportion of positive samples with HPV16, HPV18, and other high risk HPV-types were tabulated by 5-year age-groups.Results. 455,612 women were invited, and 30.2% (95 confidence interval (CI) 30.0-30.3) participated. Average age of participants was 74.6 years. Overall, 4.3% (95% CI 4.1-4.4) of participants were HPV-positive, of whom 24% had HPV 16/18. HPV-prevalence decreased slightly from 4.5% in women aged 69-73 years to 3.1% in women aged 84-88 years, but was 5.2% in the very small group of participants aged 89+ years.Conclusion. Invitation to HPV-screening was well received by elderly women. The HPV-prevalence decreased slightly with increasing age. No rebound of HPV-prevalence after menopause was found when our data were combined with previously published Danish data from younger women. The presently relatively high cervical cancer incidence in elderly women was not reflected in the HPV-prevalence.

HrHPV testing vs liquid-based cytology in cervical cancer screening among women aged 50 and older: a prospective study

“…Another limitation is that women aged 60-64 at baseline Original research were neither routinely invited again for screening nor covered by the one-time screening offer. 23 We found an overall HPV prevalence at baseline of 8.0%, which was highest (10.7%) among the youngest women (50-54 years) and lowest (5.8%) among the oldest women (65+). The figures for the youngest women were slightly higher than those reported in another Danish study of similar age groups from another area (Capital Region of Denmark) a few years' earlier (2002)(2003)(2004)(2005)).…”

“…Among women aged 65+ at baseline, follow-up was 68.1%, which is probably explained by the one-time offer of an HPV test in 2017 to all women born before 1948 (being 69+ in 2017). 23 Finally, the usefulness of the study and the results in Danish and other settings is underlined by the fact that Cobas 4800 and liquid-based cytology, are still among the most used tests in laboratories around the world.…”

<p>‘I Want the Whole Package’. Elderly Patients’ Preferences for Follow-Up After Abnormal Cervical Test Results: A Qualitative Study</p>

“…HPV-based screening is offered to women aged 60-64 years; and in 2017, the Danish Health Authorities invited women born before 1948 for a onetime HPV-based screening offer. 11 Patients with abnormal cytology or a positive HPV test are referred for colposcopy and cervical biopsy at a gynaecological outpatient clinic or at a private gynaecologist.…”

Expanding the upper age limit for cervical cancer screening: a protocol for a nationwide non-randomised intervention study

“…All HPV testing will be performed using the clinically validated and Federal Drug Agency-approved Cobas 4800 DNA test (Roche Diagnostics, Switzerland), 45 as this is the routine test platform used in the CDR. The test is an automated real-time PCR-based test designed to detect high-risk HPV types: 16,18,31,33,35,39,45,51,52,56,58,59, 66 and 68 45 46 and is validated for use on SurePath collected samples. 47 Results will be reported as (1) HPV negative, (2) HPV positive (HPV16, HPV18 and/ or other HPV types) or (3) invalid.…”

“…[14][15][16][17] However, a recent Danish study of HPV DNA prevalence in women aged 69 and above showed no increase in prevalence that could explain the cervical cancer peak at older ages. 18 The authors stated that this result may be explained by the fact that an HPV infection may become undetectable at a late stage in the oncogenic process. 18 19 It has also been hypothesised that the current peak in older ages could be attributed to an insufficient screening history in older birth cohorts.…”